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This is VAERS ID 318547

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 318547
VAERS Form:
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145D / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Barium enema abnormal, Crying

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

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxo"id (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FE


Changed on 12/8/2009

VAERS ID: 318547 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145D / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Barium enema abnormal, Crying, Intussusception, Vomiting, Emotional distress, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': (blank) WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxo"id toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FE 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 3/2/2010

VAERS ID: 318547 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 2 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B70145D / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Barium enema abnormal, Crying, Intussusception, Vomiting, Emotional distress, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 4/7/2010

VAERS ID: 318547 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 2 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145D / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Barium enema abnormal, Crying, Intussusception, Vomiting, Emotional distress, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 8/31/2010

VAERS ID: 318547 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B70145D / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Barium enema abnormal, Crying, Intussusception, Vomiting, Emotional distress, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 5/13/2013

VAERS ID: 318547 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Barium enema abnormal, Crying, Intussusception, Vomiting, Emotional distress, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 4/14/2017

VAERS ID: 318547 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Barium enema abnormal, Crying, Intussusception, Vomiting, Emotional distress, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 9/14/2017

VAERS ID: 318547 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 2 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 2 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 2 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 2/14/2018

VAERS ID: 318547 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 6/14/2018

VAERS ID: 318547 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 8/14/2018

VAERS ID: 318547 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 9/14/2018

VAERS ID: 318547 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.


Changed on 10/14/2018

VAERS ID: 318547 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Kansas
Vaccinated:2008-02-12
Onset:2008-02-29
Submitted:2008-07-08
Entered:2008-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145D / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1241U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None. PMH: NKDA
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Air contrast enema (+) for IS.
CDC 'Split Type': WAES0807USA00048

Write-up: Information has been received from a physician concerning a 6 month old male infant with no known allergies or pertinent medical history who on 12-FEB-2008 was vaccinated orally with third dose of ROTATEQ. Concomitant vaccinations included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown), Hib conj vaccine (OMPC) (manufacturer unknown) and PREVNAR. Subsequently, after receiving the third dose of ROTATEQ the patient developed intussusception. On 29-FEB-2008 the patient was hospitalized for 5 days. The patient was discharged on 05-MAR-2008. At the time of the report the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/21/2008 MR received for ER observation visit 3/2/2008 with DX: Ileocecal Intussusception. Pt presented with 3 day hx of inconsolable crying, emesis with feeds, abdominal pain and no BM or flatus. PE (+) for mild distress, abdominal distention. IS reduced by Air Contrast Enema. Post procedure pt taking po well and d/c.

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