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This is VAERS ID 282594

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 282594
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Enema administration, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception.


Changed on 12/8/2009

VAERS ID: 282594 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Vomiting, Enema administration, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 282594 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B26510E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Vomiting, Enema administration, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 282594 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Vomiting, Enema administration, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


Changed on 8/31/2010

VAERS ID: 282594 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B26510E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Vomiting, Enema administration, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 282594 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Vomiting, Enema administration, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


Changed on 5/14/2017

VAERS ID: 282594 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510E / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Vomiting, Enema administration, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 282594 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510E / 1 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 282594 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510E / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 2 MO / PO

Administered by: Private      Purchased by: Private
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


Changed on 6/14/2018

VAERS ID: 282594 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2007-05-02
Onset:2007-05-28
Submitted:2007-06-21
Entered:2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510E / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 2 MO / PO

Administered by: Private      Purchased by: Private
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC 'Split Type':

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.

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