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This is VAERS ID 281029

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 281029
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08666K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experi"enced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussu


Changed on 12/8/2009

VAERS ID: 281029 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08666K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type': (blank) WAES0705USA05367

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experi"enced experienced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussu Intussusception was an other important medical event. In follow-up, the physician reported that the patient was "doing fine." The patient started vomiting and went to the emergency room and was diagnosed with intussuception which was reduced successfully via air enema. The physician did not know if the intussusception was related to therapy with Rotateq. The records of testing prior to release of the lot in question has been rechecked and found to be satisfactory. The lot met the requirements and was released. Additional information has been requested. 6/19/07 Received vax record from PCP which confirms RO lot number but was 2nd dose, not 3rd. VAERS database updated w/same. 6/19/07 Received hospital records via fax from CDC which reveal patient admitted 5/26 & d/c on same day for persistent vomiting & dehydration. FINAL DX: Intussusception, reduced by air enema.


Changed on 3/2/2010

VAERS ID: 281029 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 2 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08666K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type': WAES0705USA05367

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experienced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussusception was an other important medical event. In follow-up, the physician reported that the patient was "doing fine." The patient started vomiting and went to the emergency room and was diagnosed with intussuception which was reduced successfully via air enema. The physician did not know if the intussusception was related to therapy with Rotateq. The records of testing prior to release of the lot in question has been rechecked and found to be satisfactory. The lot met the requirements and was released. Additional information has been requested. 6/19/07 Received vax record from PCP which confirms RO lot number but was 2nd dose, not 3rd. VAERS database updated w/same. 6/19/07 Received hospital records via fax from CDC which reveal patient admitted 5/26 & d/c on same day for persistent vomiting & dehydration. FINAL DX: Intussusception, reduced by air enema.


Changed on 4/7/2010

VAERS ID: 281029 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 2 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08666K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type': WAES0705USA05367

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experienced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussusception was an other important medical event. In follow-up, the physician reported that the patient was "doing fine." The patient started vomiting and went to the emergency room and was diagnosed with intussuception which was reduced successfully via air enema. The physician did not know if the intussusception was related to therapy with Rotateq. The records of testing prior to release of the lot in question has been rechecked and found to be satisfactory. The lot met the requirements and was released. Additional information has been requested. 6/19/07 Received vax record from PCP which confirms RO lot number but was 2nd dose, not 3rd. VAERS database updated w/same. 6/19/07 Received hospital records via fax from CDC which reveal patient admitted 5/26 & d/c on same day for persistent vomiting & dehydration. FINAL DX: Intussusception, reduced by air enema.


Changed on 8/31/2010

VAERS ID: 281029 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08666K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type': WAES0705USA05367

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experienced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussusception was an other important medical event. In follow-up, the physician reported that the patient was "doing fine." The patient started vomiting and went to the emergency room and was diagnosed with intussuception which was reduced successfully via air enema. The physician did not know if the intussusception was related to therapy with Rotateq. The records of testing prior to release of the lot in question has been rechecked and found to be satisfactory. The lot met the requirements and was released. Additional information has been requested. 6/19/07 Received vax record from PCP which confirms RO lot number but was 2nd dose, not 3rd. VAERS database updated w/same. 6/19/07 Received hospital records via fax from CDC which reveal patient admitted 5/26 & d/c on same day for persistent vomiting & dehydration. FINAL DX: Intussusception, reduced by air enema.


Changed on 5/13/2013

VAERS ID: 281029 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type': WAES0705USA05367

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experienced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussusception was an other important medical event. In follow-up, the physician reported that the patient was "doing fine." The patient started vomiting and went to the emergency room and was diagnosed with intussuception which was reduced successfully via air enema. The physician did not know if the intussusception was related to therapy with Rotateq. The records of testing prior to release of the lot in question has been rechecked and found to be satisfactory. The lot met the requirements and was released. Additional information has been requested. 6/19/07 Received vax record from PCP which confirms RO lot number but was 2nd dose, not 3rd. VAERS database updated w/same. 6/19/07 Received hospital records via fax from CDC which reveal patient admitted 5/26 & d/c on same day for persistent vomiting & dehydration. FINAL DX: Intussusception, reduced by air enema.


Changed on 5/14/2017

VAERS ID: 281029 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666K / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type': WAES0705USA05367

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experienced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussusception was an other important medical event. In follow-up, the physician reported that the patient was "doing fine." The patient started vomiting and went to the emergency room and was diagnosed with intussuception which was reduced successfully via air enema. The physician did not know if the intussusception was related to therapy with Rotateq. The records of testing prior to release of the lot in question has been rechecked and found to be satisfactory. The lot met the requirements and was released. Additional information has been requested. 6/19/07 Received vax record from PCP which confirms RO lot number but was 2nd dose, not 3rd. VAERS database updated w/same. 6/19/07 Received hospital records via fax from CDC which reveal patient admitted 5/26 & d/c on same day for persistent vomiting & dehydration. FINAL DX: Intussusception, reduced by air enema.


Changed on 9/14/2017

VAERS ID: 281029 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 2 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666K / 2 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type': WAES0705USA05367

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experienced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussusception was an other important medical event. In follow-up, the physician reported that the patient was "doing fine." The patient started vomiting and went to the emergency room and was diagnosed with intussuception which was reduced successfully via air enema. The physician did not know if the intussusception was related to therapy with Rotateq. The records of testing prior to release of the lot in question has been rechecked and found to be satisfactory. The lot met the requirements and was released. Additional information has been requested. 6/19/07 Received vax record from PCP which confirms RO lot number but was 2nd dose, not 3rd. VAERS database updated w/same. 6/19/07 Received hospital records via fax from CDC which reveal patient admitted 5/26 & d/c on same day for persistent vomiting & dehydration. FINAL DX: Intussusception, reduced by air enema.


Changed on 2/14/2018

VAERS ID: 281029 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-26
Submitted:2007-06-07
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965BA / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666K / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0030U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Vomiting, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: parent w/recent stomach virus
Allergies:
Diagnostic Lab Data: abdominal X-ray 05/26/07 LABS: abdominal x-ray revealed possible mass effect in RUQ. Air enema revealed IS & also reduced it.
CDC 'Split Type': WAES0705USA05367

Write-up: Information has been received from a physician concerning a 6 month old male who on 14-MAY-2007 was vaccinated with the third 2 ml oral dose of Rotateq (Lot # 656385/0030U). Concomitant therapy included DTaP (+) Prevnar. On 26-MAY-2007, the patient experienced intussusception. An abdominal x-ray was performed in the emergency room. Intussusception was located in the right upper quadrant and was reduced via of air enema with no difficulty. On 26-MAY-2007, the patient recovered from intussusception. Intussusception was an other important medical event. In follow-up, the physician reported that the patient was "doing fine." The patient started vomiting and went to the emergency room and was diagnosed with intussuception which was reduced successfully via air enema. The physician did not know if the intussusception was related to therapy with Rotateq. The records of testing prior to release of the lot in question has been rechecked and found to be satisfactory. The lot met the requirements and was released. Additional information has been requested. 6/19/07 Received vax record from PCP which confirms RO lot number but was 2nd dose, not 3rd. VAERS database updated w/same. 6/19/07 Received hospital records via fax from CDC which reveal patient admitted 5/26 & d/c on same day for persistent vomiting & dehydration. FINAL DX: Intussusception, reduced by air enema.


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