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This is VAERS ID 307671

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 307671
VAERS Form:
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Barium enema abnormal, Dehydration, Intussusception, Ultrasound abdomen abnormal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experie"nced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current con


Changed on 12/8/2009

VAERS ID: 307671 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Barium enema abnormal, Dehydration, Intussusception, Vomiting, Ultrasound abdomen abnormal, Urine output decreased, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': (blank) WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experie"nced experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current con conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 3/2/2010

VAERS ID: 307671 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Dehydration, Intussusception, Vomiting, Ultrasound abdomen abnormal, Urine output decreased, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 4/7/2010

VAERS ID: 307671 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Dehydration, Intussusception, Vomiting, Ultrasound abdomen abnormal, Urine output decreased, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 8/31/2010

VAERS ID: 307671 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Dehydration, Intussusception, Vomiting, Ultrasound abdomen abnormal, Urine output decreased, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 5/13/2013

VAERS ID: 307671 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Dehydration, Intussusception, Vomiting, Ultrasound abdomen abnormal, Urine output decreased, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 4/14/2017

VAERS ID: 307671 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Dehydration, Intussusception, Vomiting, Ultrasound abdomen abnormal, Urine output decreased, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 9/14/2017

VAERS ID: 307671 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / - UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Intussusception, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 2/14/2018

VAERS ID: 307671 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Intussusception, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 6/14/2018

VAERS ID: 307671 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Intussusception, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 8/14/2018

VAERS ID: 307671 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Intussusception, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 9/14/2018

VAERS ID: 307671 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Intussusception, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.


Changed on 10/14/2018

VAERS ID: 307671 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Georgia
Vaccinated:2008-01-10
Onset:2008-03-03
Submitted:2008-03-20
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, Intussusception, X-ray gastrointestinal tract normal

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: None
Allergies:
Diagnostic Lab Data: upper GI series X-ray 03/03/08 no reflux; barium enema X-ray 03/03/08 intussusception 4/28/08-records received- UGI normal. Abdominal US consistent with intussusception. Air enema succesful reduction ileocolic intussusception.
CDC 'Split Type': WAES0803USA01464

Write-up: Information has been received from a physician concerning a 6 month old female who on 09-NOV-2007 and 10-JAN-2008 was vaccinated with her first and second doses of Rotateq (lot# 656841/1168U, 657673/0904U). In March 2008 (date unknown) the patient experienced intussusception and was hospitalized (length of stay unknown). Therapy with Rotateq was discontinued. There was no product quality complaint. Follow-up information from the reporting physician indicated that the 6 month old female with no current conditions or medical history who on 10-JAN-2008 was vaccinated with her second dose of Rotateq. Concomitant vaccinations administered on that same day included a dose of Comvax (OMPC) (MSD), a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of PREVNAR. On 03-MAR-2008 the patient started with symptoms of vomiting which was the only symptom. There was no diarrhea. The patient was hospitalized for three or four days and had no stool in the hospital. An upper GI was performed questioning reflux but no reflux was noted. A barium enema was performed and the patient was diagnosed with intussusception. The event was not life-threatening. The patient was due back in the office this month and the physician was unsure if she was going to give the third dose of Rotateq. Subsequently, the patient recovered. The physician stated that there was no way she''ll know if Rotateq caused the intussusception. Additional information has been requested. 4/28/08-records received-for DOS 3/3-3/5/08-DX DC: Intussusception. Presented with 5 episodes vomiting bilious. Decreased urine output. No diarrhea. Mildly dehydrated.

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