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VAERS ID: | 292397 |
VAERS Form: | |
Age: | 0.5 |
Sex: | Male |
Location: | Florida |
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 2 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 2 | LL / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B47442H / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Irritability, Pyrexia, Bowel movement irregularity
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomi"ting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vom
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 2 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 2 | LL / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B47442H / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 | - / PO |
Administered by: Private Purchased by: Unknown Other
Symptoms: Barium enema, Intussusception, Irritability, Pyrexia, Vomiting, Ultrasound abdomen abnormal, Bowel movement irregularity
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''''s doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomi"ting. vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vom Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 2 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 2 | LL / - |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B47442H / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 | - / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception, Irritability, Pyrexia, Vomiting, Ultrasound abdomen abnormal, Bowel movement irregularity
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 2 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 2 | LL / - |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B47442H / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 | - / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception, Irritability, Pyrexia, Vomiting, Ultrasound abdomen abnormal, Bowel movement irregularity
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 2 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 2 | LL / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B47442H / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 | - / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception, Irritability, Pyrexia, Vomiting, Ultrasound abdomen abnormal, Bowel movement irregularity
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 2 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 2 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 | - / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception, Irritability, Pyrexia, Vomiting, Ultrasound abdomen abnormal, Bowel movement irregularity
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 2 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 2 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 2 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 | - / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception, Irritability, Pyrexia, Vomiting, Ultrasound abdomen abnormal, Bowel movement irregularity
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 2 3 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 2 3 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 2 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 2 3 | - MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 3 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 3 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 3 | MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 3 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 3 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 3 | MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 3 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 3 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 3 | MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 3 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 3 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 3 | MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 3 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 3 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 3 | MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 3 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 3 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 3 | MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
Vaccinated: | 2007-09-20 |
Onset: | 2007-10-08 |
Submitted: | 2007-10-08 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2765AA / 3 | LL / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF204AC / 3 | LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B47442H / 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0509U / 3 | MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema, Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1
Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.
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