National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 292243

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 292243
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845H / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal tenderness, Abnormal faeces, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type':

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. A"n abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There w


Changed on 12/8/2009

VAERS ID: 292243 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845H / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Abdominal tenderness, Abnormal faeces, Crying, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': (blank) WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. A"n An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There w was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 3/2/2010

VAERS ID: 292243 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 2 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B58845H / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Abnormal faeces, Crying, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 4/7/2010

VAERS ID: 292243 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 2 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845H / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Abnormal faeces, Crying, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 8/31/2010

VAERS ID: 292243 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B58845H / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Abnormal faeces, Crying, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 5/13/2013

VAERS ID: 292243 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Abnormal faeces, Crying, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 2/14/2017

VAERS ID: 292243 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Abnormal faeces, Crying, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 9/14/2017

VAERS ID: 292243 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 2 3 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 2 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 2 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 2 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 2/14/2018

VAERS ID: 292243 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 3 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 6/14/2018

VAERS ID: 292243 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 3 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 8/14/2018

VAERS ID: 292243 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 3 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 9/14/2018

VAERS ID: 292243 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 3 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


Changed on 10/14/2018

VAERS ID: 292243 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:New York
Vaccinated:2007-07-24
Onset:2007-09-24
Submitted:2007-10-04
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 3 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC 'Split Type': WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=292243&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166