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This is VAERS ID 301249

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 301249
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 0 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 0 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35A4 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Intussusception, Surgery

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP", a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered.


Changed on 12/8/2009

VAERS ID: 301249 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 0 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 0 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35A4 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Diet refusal, Haematochezia, Intussusception, Nasal congestion, Screaming, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: (blank) 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC 'Split Type': (blank) WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP", DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


Changed on 3/2/2010

VAERS ID: 301249 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 0 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 0 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 0 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C35A4 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Intussusception, Nasal congestion, Screaming, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC 'Split Type': WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


Changed on 4/7/2010

VAERS ID: 301249 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 0 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 0 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 0 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35A4 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Intussusception, Nasal congestion, Screaming, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC 'Split Type': WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


Changed on 8/31/2010

VAERS ID: 301249 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 0 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 0 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C35A4 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Intussusception, Nasal congestion, Screaming, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC 'Split Type': WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


Changed on 5/13/2013

VAERS ID: 301249 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 0 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 0 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35A4 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Intussusception, Nasal congestion, Screaming, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC 'Split Type': WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


Changed on 2/14/2017

VAERS ID: 301249 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 0 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 0 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35A4 / 0 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Intussusception, Nasal congestion, Screaming, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC 'Split Type': WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


Changed on 9/14/2017

VAERS ID: 301249 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 0 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 0 1 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 0 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35A4 / 0 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC 'Split Type': WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


Changed on 2/14/2018

VAERS ID: 301249 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-10-25
Onset:2007-11-22
Submitted:2007-12-28
Entered:2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 1 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35A4 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 1 MO / PO

Administered by: Other      Purchased by: Other
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC 'Split Type': WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


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