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This is VAERS ID 277899

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 277899
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 0 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 0 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08681D / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Irritability, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007,"the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose


Changed on 12/8/2009

VAERS ID: 277899 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 0 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 0 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08681D / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 UN / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Barium double contrast, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': (blank) WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007,"the 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 3/2/2010

VAERS ID: 277899 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 0 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 0 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08681D / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 4/7/2010

VAERS ID: 277899 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 0 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 0 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08681D / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 8/31/2010

VAERS ID: 277899 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 0 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 0 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08681D / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 5/13/2013

VAERS ID: 277899 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 0 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 0 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 5/14/2017

VAERS ID: 277899 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 0 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 0 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 0 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Haematochezia, Intussusception, Irritability, Vomiting, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 9/14/2017

VAERS ID: 277899 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 0 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 0 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 0 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 2/14/2018

VAERS ID: 277899 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 6/14/2018

VAERS ID: 277899 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 8/14/2018

VAERS ID: 277899 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 9/14/2018

VAERS ID: 277899 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


Changed on 10/14/2018

VAERS ID: 277899 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-03-29
Onset:2007-04-23
Submitted:2007-05-03
Entered:2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC 'Split Type': WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.

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