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This is VAERS ID 277567

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 277567
VAERS Form:
Age:0.6
Gender: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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

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.

Changed on 12/8/2009

VAERS ID: 277567 Before After
VAERS Form:
Age:0.6
Gender: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 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': (blank) WAES0704USA04328

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", 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.

Changed on 5/13/2013

VAERS ID: 277567 Before After
VAERS Form:
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': WAES0704USA04328

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.

Changed on 2/14/2017

VAERS ID: 277567 Before After
VAERS Form:
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': WAES0704USA04328

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.

Changed on 9/14/2017

VAERS ID: 277567 Before After
VAERS Form:(blank) 1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': WAES0704USA04328

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.

Changed on 2/14/2018

VAERS ID: 277567 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': WAES0704USA04328

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.

Changed on 6/14/2018

VAERS ID: 277567 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': WAES0704USA04328

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.

Changed on 8/14/2018

VAERS ID: 277567 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': WAES0704USA04328

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.

Changed on 9/14/2018

VAERS ID: 277567 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': WAES0704USA04328

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.

Changed on 10/14/2018

VAERS ID: 277567 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown medical records received 5/2/07-PMH RSV. Pneumonia.
Allergies:
Diagnostic Lab Data: Unknown records received 5/2/07-Barium enema
CDC 'Split Type': WAES0704USA04328

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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