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This is VAERS ID 291938

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 291938
VAERS Form:
Age:0.4
Gender:Male
Location:Kansas
Vaccinated:2007-08-20
Onset:2007-09-18
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 1 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

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

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''''s recovery stat"us was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.

Changed on 12/8/2009

VAERS ID: 291938 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Kansas
Vaccinated:2007-08-20
Onset:2007-09-18
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 1 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/6/07-records received-intussusception reduced by air enema.
CDC 'Split Type': (blank) WAES0709USA04474

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''''s patient''s recovery stat"us status was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 11/6/07-records received for DOS 9/19-9/20/07-intussusception reduced by air enema. History of bloody stools and emesis. Observed after procedure, tolerated breast feeding, discharged.

Changed on 5/13/2013

VAERS ID: 291938 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Kansas
Vaccinated:2007-08-20
Onset:2007-09-18
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/6/07-records received-intussusception reduced by air enema.
CDC 'Split Type': WAES0709USA04474

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''s recovery status was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 11/6/07-records received for DOS 9/19-9/20/07-intussusception reduced by air enema. History of bloody stools and emesis. Observed after procedure, tolerated breast feeding, discharged.

Changed on 4/14/2017

VAERS ID: 291938 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Kansas
Vaccinated:2007-08-20
Onset:2007-09-18
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/6/07-records received-intussusception reduced by air enema.
CDC 'Split Type': WAES0709USA04474

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''s recovery status was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 11/6/07-records received for DOS 9/19-9/20/07-intussusception reduced by air enema. History of bloody stools and emesis. Observed after procedure, tolerated breast feeding, discharged.

Changed on 9/14/2017

VAERS ID: 291938 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Kansas
Vaccinated:2007-08-20
Onset:2007-09-18
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/6/07-records received-intussusception reduced by air enema.
CDC 'Split Type': WAES0709USA04474

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''s recovery status was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 11/6/07-records received for DOS 9/19-9/20/07-intussusception reduced by air enema. History of bloody stools and emesis. Observed after procedure, tolerated breast feeding, discharged.

Changed on 2/14/2018

VAERS ID: 291938 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Kansas
Vaccinated:2007-08-20
Onset:2007-09-18
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/6/07-records received-intussusception reduced by air enema.
CDC 'Split Type': WAES0709USA04474

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''s recovery status was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 11/6/07-records received for DOS 9/19-9/20/07-intussusception reduced by air enema. History of bloody stools and emesis. Observed after procedure, tolerated breast feeding, discharged.

Changed on 6/14/2018

VAERS ID: 291938 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Kansas
Vaccinated:2007-08-20
Onset:2007-09-18
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/6/07-records received-intussusception reduced by air enema.
CDC 'Split Type': WAES0709USA04474

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''s recovery status was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 11/6/07-records received for DOS 9/19-9/20/07-intussusception reduced by air enema. History of bloody stools and emesis. Observed after procedure, tolerated breast feeding, discharged.

Changed on 8/14/2018

VAERS ID: 291938 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Kansas
Vaccinated:2007-08-20
Onset:2007-09-18
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/6/07-records received-intussusception reduced by air enema.
CDC 'Split Type': WAES0709USA04474

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''s recovery status was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 11/6/07-records received for DOS 9/19-9/20/07-intussusception reduced by air enema. History of bloody stools and emesis. Observed after procedure, tolerated breast feeding, discharged.

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