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This is VAERS ID 292397

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type': None

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

Changed on 12/8/2009

VAERS ID: 292397 Before After
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 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type': None (blank)

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.

Changed on 3/2/2010

VAERS ID: 292397 Before After
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) 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 4/7/2010

VAERS ID: 292397 Before After
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 (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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 8/31/2010

VAERS ID: 292397 Before After
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 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 5/13/2013

VAERS ID: 292397 Before After
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) / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 4/14/2017

VAERS ID: 292397 Before After
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) / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0~In name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 9/14/2017

VAERS ID: 292397 Before After
VAERS Form:(blank) 1
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 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 2/14/2018

VAERS ID: 292397 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 6/14/2018

VAERS ID: 292397 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 8/14/2018

VAERS ID: 292397 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 9/14/2018

VAERS ID: 292397 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 10/14/2018

VAERS ID: 292397 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 12/24/2020

VAERS ID: 292397 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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.

Changed on 12/30/2020

VAERS ID: 292397 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC 'Split Type':

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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