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This is VAERS ID 290934

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 290934
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Appendicectomy, Intussusception, Pyrexia, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergen"cy room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was i


Changed on 12/8/2009

VAERS ID: 290934 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Appendicectomy, Intussusception, Pyrexia, Surgery, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': (blank) WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergen"cy emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was i involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 3/2/2010

VAERS ID: 290934 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Pyrexia, Surgery, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 4/7/2010

VAERS ID: 290934 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Pyrexia, Surgery, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 8/31/2010

VAERS ID: 290934 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Pyrexia, Surgery, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 5/13/2013

VAERS ID: 290934 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Pyrexia, Surgery, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 4/14/2017

VAERS ID: 290934 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Pyrexia, Surgery, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 9/14/2017

VAERS ID: 290934 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / - UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UNK UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 2 3 - MO / PO

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

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 2/14/2018

VAERS ID: 290934 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 3 MO / PO

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

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 6/14/2018

VAERS ID: 290934 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 3 MO / PO

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

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 8/14/2018

VAERS ID: 290934 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 3 MO / PO

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

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 9/14/2018

VAERS ID: 290934 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 3 MO / PO

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

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


Changed on 10/14/2018

VAERS ID: 290934 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-06-11
Onset:2007-07-07
Submitted:2007-09-19
Entered:2007-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 3 MO / PO

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

Life Threatening? Yes
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC 'Split Type': WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.

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