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This is VAERS ID 279891

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 279891
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Bacteria urine

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# /"1116D,/" 656188/1238F, and 656194/0024U) on 17-JAN-20"07, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No


Changed on 12/8/2009

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio
CDC 'Split Type': (blank) WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# /"1116D,/" "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-20"07, 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 3/2/2010

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 4/7/2010

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 8/31/2010

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 4/13/2011

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 5/13/2011

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 6/11/2011

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 1/7/2013

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio reduction.
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 5/13/2013

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reduction.
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 6/14/2014

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reduction.
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 3/14/2015

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reduction.
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 2/14/2017

VAERS ID: 279891 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Barium double contrast, Eyes sunken, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Vomiting, White blood cells urine positive, Fluid intake reduced, Bacteria urine, Urine analysis 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reduction.
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 9/14/2017

VAERS ID: 279891 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reduction.
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 2/14/2018

VAERS ID: 279891 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reduction.
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


Changed on 6/14/2018

VAERS ID: 279891 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-03-02
Onset:2007-04-26
Submitted:2007-05-25
Entered:2007-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reduction.
CDC 'Split Type': WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.

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