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This is VAERS ID 285492

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 285492
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a office manager in a physician''''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who"was vaccinated with a first, second, and third dose of Rotateq on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating tha


Changed on 12/8/2009

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': (blank) WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''''s physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who"was who was vaccinated with a first, second, and third dose of Rotateq on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating tha that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 1/5/2010

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / - UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of Rotateq ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 4/13/2011

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 5/13/2011

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 6/11/2011

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 5/13/2013

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 7/7/2013

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 6/14/2014

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 2/14/2017

VAERS ID: 285492 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 9/14/2017

VAERS ID: 285492 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 6 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 2/14/2018

VAERS ID: 285492 Before After
VAERS Form:1
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 6 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 6/14/2018

VAERS ID: 285492 Before After
VAERS Form:1
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 6 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 8/14/2018

VAERS ID: 285492 Before After
VAERS Form:1
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 6 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


Changed on 9/14/2018

VAERS ID: 285492 Before After
VAERS Form:1
Age:0.6
Gender:Female
Location:Texas
Vaccinated:2007-03-15
Onset:2007-06-10
Submitted:2007-07-20
Entered:2007-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 6 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC 'Split Type': WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.

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