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VAERS ID: | 277567 |
VAERS Form: | |
Age: | 0.6 |
Sex: | Male |
Location: | North Carolina |
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 2 | - / PO |
Administered by: Other Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery", but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 2 | - / PO |
Administered by: Other Purchased by: Unknown Other
Symptoms: Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery",
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 2 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 2 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 2 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 2 3 | - MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 3 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 3 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 3 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 3 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 3 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 3 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
Vaccinated: | 2007-03-28 |
Onset: | 2007-04-15 |
Submitted: | 2007-04-27 |
Entered: | 2007-04-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1238F / 3 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated PO with a third dose of Rotateq. Subsequently, about a month after vaccination, the patient experienced intussusception. It was noted that the patient had surgery, but no additional information was available. There was no product quality complaint. Intussusception was considered to be immediately life-threatening and disabling and an other important medical event. Additional information has been requested. 05/02/07-records received for DOS 04/15-04/17/07-DC DX:Intussusception. Presented with sudden onset of emesis and bloody stool. Barium enema and attempt to reduce radiologiclly was unsuccessful. Surgery laprascopic reduction and appendectomy.
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