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This is VAERS ID 300041

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 300041
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B540168 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Barium enema, Blood gases abnormal, Blood sodium decreased

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done.
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it.


Changed on 12/8/2009

VAERS ID: 300041 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B540168 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Barium enema, Blood gases abnormal, Blood sodium decreased, Blood urea decreased, Cough, Intussusception, Laparotomy, Nausea, Neutrophil count increased, Sputum discoloured, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Adenovirus infection, X-ray gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 1/22/08-records received-viral infection requiring breathing treatments and steroids.
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done. 12/31/07-records received-Two view abdomen x-ray normal bowel gas pattern. 1/22/08-records received-Upper GI series-normal with single episode of aspiration. Abdominal x-ray-intussuscepti
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it. 12/31/07-records received for DOS 12/13/07-ER visit C/O choking on sputum, coughs up yellowish color sputum. 1/22/08-records received for DOS 12/13-12/16/07-DC DX: Intussusception. Presented with 1 day history of nausea and vomiting.


Changed on 3/2/2010

VAERS ID: 300041 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B540168 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Barium enema, Blood gases abnormal, Blood sodium decreased, Blood urea decreased, Cough, Intussusception, Laparotomy, Nausea, Neutrophil count increased, Sputum discoloured, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Adenovirus infection, X-ray gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 1/22/08-records received-viral infection requiring breathing treatments and steroids.
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done. 12/31/07-records received-Two view abdomen x-ray normal bowel gas pattern. 1/22/08-records received-Upper GI series-normal with single episode of aspiration. Abdominal x-ray-intussuscepti
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it. 12/31/07-records received for DOS 12/13/07-ER visit C/O choking on sputum, coughs up yellowish color sputum. 1/22/08-records received for DOS 12/13-12/16/07-DC DX: Intussusception. Presented with 1 day history of nausea and vomiting.


Changed on 4/7/2010

VAERS ID: 300041 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B540168 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Barium enema, Blood gases abnormal, Blood sodium decreased, Blood urea decreased, Cough, Intussusception, Laparotomy, Nausea, Neutrophil count increased, Sputum discoloured, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Adenovirus infection, X-ray gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 1/22/08-records received-viral infection requiring breathing treatments and steroids.
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done. 12/31/07-records received-Two view abdomen x-ray normal bowel gas pattern. 1/22/08-records received-Upper GI series-normal with single episode of aspiration. Abdominal x-ray-intussuscepti
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it. 12/31/07-records received for DOS 12/13/07-ER visit C/O choking on sputum, coughs up yellowish color sputum. 1/22/08-records received for DOS 12/13-12/16/07-DC DX: Intussusception. Presented with 1 day history of nausea and vomiting.


Changed on 8/31/2010

VAERS ID: 300041 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B540168 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Barium enema, Blood gases abnormal, Blood sodium decreased, Blood urea decreased, Cough, Intussusception, Laparotomy, Nausea, Neutrophil count increased, Sputum discoloured, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Adenovirus infection, X-ray gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 1/22/08-records received-viral infection requiring breathing treatments and steroids.
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done. 12/31/07-records received-Two view abdomen x-ray normal bowel gas pattern. 1/22/08-records received-Upper GI series-normal with single episode of aspiration. Abdominal x-ray-intussuscepti
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it. 12/31/07-records received for DOS 12/13/07-ER visit C/O choking on sputum, coughs up yellowish color sputum. 1/22/08-records received for DOS 12/13-12/16/07-DC DX: Intussusception. Presented with 1 day history of nausea and vomiting.


Changed on 5/13/2013

VAERS ID: 300041 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540168 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Barium enema, Blood gases abnormal, Blood sodium decreased, Blood urea decreased, Cough, Intussusception, Laparotomy, Nausea, Neutrophil count increased, Sputum discoloured, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Adenovirus infection, X-ray gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 1/22/08-records received-viral infection requiring breathing treatments and steroids.
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done. 12/31/07-records received-Two view abdomen x-ray normal bowel gas pattern. 1/22/08-records received-Upper GI series-normal with single episode of aspiration. Abdominal x-ray-intussuscepti
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it. 12/31/07-records received for DOS 12/13/07-ER visit C/O choking on sputum, coughs up yellowish color sputum. 1/22/08-records received for DOS 12/13-12/16/07-DC DX: Intussusception. Presented with 1 day history of nausea and vomiting.


Changed on 4/14/2017

VAERS ID: 300041 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540168 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Barium enema, Blood gases abnormal, Blood sodium decreased, Blood urea decreased, Cough, Intussusception, Laparotomy, Nausea, Neutrophil count increased, Sputum discoloured, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Adenovirus infection, X-ray gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 1/22/08-records received-viral infection requiring breathing treatments and steroids.
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done. 12/31/07-records received-Two view abdomen x-ray normal bowel gas pattern. 1/22/08-records received-Upper GI series-normal with single episode of aspiration. Abdominal x-ray-intussuscepti x-ray-intussusception. Air Enema with residual contrast-intussusception mid transverse colon. Surgery exploratory laparotomy and appendectomy. WBC 15.91, neutrophil 78.0, sodium 135, BUN 4. 4/15/08-Path report received 2/13/08-appendix with adenovirus infection. positive immunohistochemical evidence of adenovirus. No immunohistochemical evidence of rotovirus. krk
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it. 12/31/07-records received for DOS 12/13/07-ER visit C/O choking on sputum, coughs up yellowish color sputum. 1/22/08-records received for DOS 12/13-12/16/07-DC DX: Intussusception. Presented with 1 day history of nausea and vomiting.


Changed on 9/14/2017

VAERS ID: 300041 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 2 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 3 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540168 / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract, X-ray gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 1/22/08-records received-viral infection requiring breathing treatments and steroids.
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done. 12/31/07-records received-Two view abdomen x-ray normal bowel gas pattern. 1/22/08-records received-Upper GI series-normal with single episode of aspiration. Abdominal x-ray-intussusception. Air Enema with residual contrast-intussusception mid transverse colon. Surgery exploratory laparotomy and appendectomy. WBC 15.91, neutrophil 78.0, sodium 135, BUN 4. 4/15/08-Path report received 2/13/08-appendix with adenovirus infection. positive immunohistochemical evidence of adenovirus. No immunohistochemical evidence of rotovirus. krk
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it. 12/31/07-records received for DOS 12/13/07-ER visit C/O choking on sputum, coughs up yellowish color sputum. 1/22/08-records received for DOS 12/13-12/16/07-DC DX: Intussusception. Presented with 1 day history of nausea and vomiting.


Changed on 2/14/2018

VAERS ID: 300041 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2007-12-10
Onset:2007-12-13
Submitted:2007-12-17
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C27690AA / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 3 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540168 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract, X-ray gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 1/22/08-records received-viral infection requiring breathing treatments and steroids.
Allergies:
Diagnostic Lab Data: UGI and KUB as well as a barium enema was done. 12/31/07-records received-Two view abdomen x-ray normal bowel gas pattern. 1/22/08-records received-Upper GI series-normal with single episode of aspiration. Abdominal x-ray-intussusception. Air Enema with residual contrast-intussusception mid transverse colon. Surgery exploratory laparotomy and appendectomy. WBC 15.91, neutrophil 78.0, sodium 135, BUN 4. 4/15/08-Path report received 2/13/08-appendix with adenovirus infection. positive immunohistochemical evidence of adenovirus. No immunohistochemical evidence of rotovirus. krk
CDC 'Split Type':

Write-up: Had an intussusception 3 days after the Rotateq was given. Pt did require surgery to reduce it. 12/31/07-records received for DOS 12/13/07-ER visit C/O choking on sputum, coughs up yellowish color sputum. 1/22/08-records received for DOS 12/13-12/16/07-DC DX: Intussusception. Presented with 1 day history of nausea and vomiting.


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