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This is VAERS ID 309327

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 309327
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 1 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 1 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 1 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful redu
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008"the patient experienced illness with vomiting for 24 hours and was seen in the physician''''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalize


Changed on 12/8/2009

VAERS ID: 309327 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 1 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 1 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 1 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Pyrexia, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful redu
CDC 'Split Type': (blank) WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008"the 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''''s physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalize hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.


Changed on 5/13/2013

VAERS ID: 309327 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 1 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 1 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Pyrexia, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful redu
CDC 'Split Type': WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.


Changed on 4/14/2017

VAERS ID: 309327 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 1 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 1 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Pyrexia, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful redu reduction.
CDC 'Split Type': WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.


Changed on 9/14/2017

VAERS ID: 309327 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 1 2 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 1 2 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 1 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful reduction.
CDC 'Split Type': WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.


Changed on 2/14/2018

VAERS ID: 309327 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 2 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 2 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful reduction.
CDC 'Split Type': WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.


Changed on 6/14/2018

VAERS ID: 309327 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 2 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 2 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful reduction.
CDC 'Split Type': WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.


Changed on 8/14/2018

VAERS ID: 309327 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 2 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 2 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful reduction.
CDC 'Split Type': WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.


Changed on 9/14/2018

VAERS ID: 309327 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 2 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 2 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful reduction.
CDC 'Split Type': WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.


Changed on 10/14/2018

VAERS ID: 309327 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-01-18
Onset:2008-03-07
Submitted:2008-04-10
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC1UB062AA / 2 RL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0U98U / 2 RL / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B5U013H / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Dehydration, Intussusception, Malaise, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 03/08/08 intussusception; Laboratory test 03/08/08 air enema reduced. 4/28/08-records received-X-ray abdomen: multiple dilated loops of small bowel suggesting bowel obstruction. Air enema administration successful reduction.
CDC 'Split Type': WAES0804USA00891

Write-up: Information has been received from a physician concerning a 24 week old male with no pertinent medical history who on 16-NOV-2007 and 18-JAN-2008 was vaccinated with his first and second doses of ROTATEQ (lot# 657671/0902U, 657635/0770U). On 07-MAR-2008 the patient experienced illness with vomiting for 24 hours and was seen in the physician''s office on 08-MAR-2008. On 08-MAR-2008 the patient was diagnosed with intussusception characterized by vomiting, dehydration and abdominal pain and was hospitalized for one night for observation. There was no diarrhea or blood in the stool reported. The patient was treated with IV rehydration in the emergency room. The intussusception was successfully reduced via air enema. It was noted that on 18-MAR-2008 the patient received the third dose of ROTATEQ (lot# 659917/0017X). Therapy with ROTATEQ was discontinued. On 09-MAR-2008 the patient was discharged from the hospital and was recovered. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event by the physician. Additional information has been requested. 4/28/08-records received for DOS 3/8-3/9/08-DC DX: Intussusception. Presented to ED with 1 1/2 day C/O vomiting, dehydration and fever 101. No currant jelly or bloody stools.

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