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This is VAERS ID 277111

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 277111
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Diarrhoea haemorrhagic, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP."On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requ


Changed on 12/8/2009

VAERS ID: 277111 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Barium double contrast, Crying, Diarrhoea haemorrhagic, Intussusception, Lethargy, Vomiting, Wrong drug administered, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': (blank) WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP."On DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requ requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 7/31/2010

VAERS ID: 277111 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Crying, Diarrhoea haemorrhagic, Intussusception, Lethargy, Vomiting, Wrong drug administered, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 4/13/2011

VAERS ID: 277111 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Crying, Diarrhoea haemorrhagic, Intussusception, Lethargy, Vomiting, Wrong drug administered, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 5/13/2011

VAERS ID: 277111 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Crying, Diarrhoea haemorrhagic, Intussusception, Lethargy, Vomiting, Wrong drug administered, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 6/11/2011

VAERS ID: 277111 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Crying, Diarrhoea haemorrhagic, Intussusception, Lethargy, Vomiting, Wrong drug administered, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 5/13/2013

VAERS ID: 277111 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Crying, Diarrhoea haemorrhagic, Intussusception, Lethargy, Vomiting, Wrong drug administered, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 2/14/2017

VAERS ID: 277111 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Crying, Diarrhoea haemorrhagic, Intussusception, Lethargy, Vomiting, Wrong drug administered, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 9/14/2017

VAERS ID: 277111 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 3 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 3 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 2/14/2018

VAERS ID: 277111 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 3 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 3 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 6/14/2018

VAERS ID: 277111 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 3 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 3 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 8/14/2018

VAERS ID: 277111 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 3 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 3 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


Changed on 9/14/2018

VAERS ID: 277111 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-01
Onset:2007-03-19
Submitted:2007-04-19
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 3 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 3 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Wrong drug administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC 'Split Type': WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.

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