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This is VAERS ID 308326

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308326
VAERS Form:
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - 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. - / 0 UN / UN

Administered by: Other      Purchased by: Unknown
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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a nurse practitioner concerning a /"previously healthy/" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecifie"d) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving h


Changed on 12/8/2009

VAERS ID: 308326 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - 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. - / 0 UN / UN

Administered by: Other      Purchased by: Unknown 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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a /"previously healthy/" "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecifie"d) (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving h his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 3/2/2010

VAERS ID: 308326 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - 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. - / 0 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 4/7/2010

VAERS ID: 308326 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - 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. - / 0 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 8/31/2010

VAERS ID: 308326 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - 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. - / 0 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 5/13/2013

VAERS ID: 308326 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - 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. - / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 308326 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - 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. - / 0 1 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 308326 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 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. - / 1 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 308326 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 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. - / 1 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 308326 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 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. - / 1 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 308326 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 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. - / 1 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 308326 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2008-01-31
Submitted:2008-03-26
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 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. - / 1 UN / UN

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: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0803USA03061

Write-up: Information has been received from a nurse practitioner concerning a "previously healthy" 4 month old male who was vaccinated with the first dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, PREVNAR, Hib conj vaccine (unspecified carrier (manufacturer unknown), and poliovirus vaccine. At the end of January or early February 2008, the patient was observed for 23 hours in the hospital for intussusception after receiving his first dose of ROTATEQ. No lot number was provided. Subsequently, the patient recovered from intussusception on an unspecified date. Therapy with ROTATEQ was not reintroduced. There was no product quality complaint. Additional information has been requested.

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