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This is VAERS ID 308061

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308061
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal discomfort, Abdominal tenderness, Barium double contrast, Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious v"omiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 12/8/2009

VAERS ID: 308061 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal discomfort, Abdominal tenderness, Barium double contrast, Intussusception, Vomiting, Enema administration, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious v"omiting vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 5/13/2013

VAERS ID: 308061 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal discomfort, Abdominal tenderness, Barium double contrast, Intussusception, Vomiting, Enema administration, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 4/14/2017

VAERS ID: 308061 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal discomfort, Abdominal tenderness, Barium double contrast, Intussusception, Vomiting, Enema administration, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 9/14/2017

VAERS ID: 308061 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 2/14/2018

VAERS ID: 308061 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 6/14/2018

VAERS ID: 308061 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 8/14/2018

VAERS ID: 308061 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 9/14/2018

VAERS ID: 308061 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


Changed on 10/14/2018

VAERS ID: 308061 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2007-08-23
Onset:2008-01-13
Submitted:2008-01-22
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC 'Split Type':

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.

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