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This is VAERS ID 300086

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 300086
VAERS Form:
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 2 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 854007D / 2 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain upper, Barium enema abnormal, Blood potassium increased, Dehydration, Gastroenteritis viral

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type':

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0"138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recov


Changed on 12/8/2009

VAERS ID: 300086 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 2 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 854007D / 2 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain upper, Barium enema abnormal, Blood potassium increased, Dehydration, Gastroenteritis viral, Intussusception, Nausea, Vomiting projectile, Protein urine present, Urine ketone body present

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': (blank) WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0"138F). 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recov recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 3/2/2010

VAERS ID: 300086 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 2 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 2 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 854007D / 2 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Barium enema abnormal, Blood potassium increased, Dehydration, Gastroenteritis viral, Intussusception, Nausea, Vomiting projectile, Protein urine present, Urine ketone body present

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 4/7/2010

VAERS ID: 300086 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 2 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 2 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 854007D / 2 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Barium enema abnormal, Blood potassium increased, Dehydration, Gastroenteritis viral, Intussusception, Nausea, Vomiting projectile, Protein urine present, Urine ketone body present

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 8/31/2010

VAERS ID: 300086 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 2 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 854007D / 2 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Barium enema abnormal, Blood potassium increased, Dehydration, Gastroenteritis viral, Intussusception, Nausea, Vomiting projectile, Protein urine present, Urine ketone body present

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 5/13/2013

VAERS ID: 300086 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 2 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 2 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Barium enema abnormal, Blood potassium increased, Dehydration, Gastroenteritis viral, Intussusception, Nausea, Vomiting projectile, Protein urine present, Urine ketone body present

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 2/14/2017

VAERS ID: 300086 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 2 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Barium enema abnormal, Blood potassium increased, Dehydration, Gastroenteritis viral, Intussusception, Nausea, Vomiting projectile, Protein urine present, Urine ketone body present

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 9/14/2017

VAERS ID: 300086 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 2 3 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 2 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 2 3 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 2/14/2018

VAERS ID: 300086 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 3 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 3 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 6/14/2018

VAERS ID: 300086 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 3 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 3 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 8/14/2018

VAERS ID: 300086 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 3 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 3 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


Changed on 9/14/2018

VAERS ID: 300086 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Texas
Vaccinated:2007-08-14
Onset:2007-10-04
Submitted:2007-12-14
Entered:2007-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 3 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 3 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC 'Split Type': WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.

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