National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 333225

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 333225
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 027701 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal mass, Alanine aminotransferase increased, Aspartate aminotransferase increased, Barium double contrast, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (l"ot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hosp


Changed on 12/8/2009

VAERS ID: 333225 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 027701 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal mass, Alanine aminotransferase increased, Aspartate aminotransferase increased, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, No reaction on previous exposure to drug, Protein urine present, Scan brain, Abdominal X-ray, Hypophagia, Head titubation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': (blank) WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (l"ot (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hosp hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 3/2/2010

VAERS ID: 333225 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 1 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 027701 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Alanine aminotransferase increased, Aspartate aminotransferase increased, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, No reaction on previous exposure to drug, Protein urine present, Scan brain, Abdominal X-ray, Hypophagia, Head titubation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 4/7/2010

VAERS ID: 333225 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 1 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 027701 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Alanine aminotransferase increased, Aspartate aminotransferase increased, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, No reaction on previous exposure to drug, Protein urine present, Scan brain, Abdominal X-ray, Hypophagia, Head titubation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 8/31/2010

VAERS ID: 333225 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 027701 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Alanine aminotransferase increased, Aspartate aminotransferase increased, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, No reaction on previous exposure to drug, Protein urine present, Scan brain, Abdominal X-ray, Hypophagia, Head titubation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 5/13/2013

VAERS ID: 333225 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Alanine aminotransferase increased, Aspartate aminotransferase increased, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, No reaction on previous exposure to drug, Protein urine present, Scan brain, Abdominal X-ray, Hypophagia, Head titubation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 4/14/2017

VAERS ID: 333225 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Alanine aminotransferase increased, Aspartate aminotransferase increased, Barium double contrast, Barium enema abnormal, Intussusception, Irritability, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, No reaction on previous exposure to drug, Protein urine present, Scan brain, Abdominal X-ray, Hypophagia, Head titubation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 9/14/2017

VAERS ID: 333225 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 1 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 1 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 1 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 1 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, No reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 2/14/2018

VAERS ID: 333225 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, No reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 6/14/2018

VAERS ID: 333225 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, No reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 8/14/2018

VAERS ID: 333225 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, No reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 9/14/2018

VAERS ID: 333225 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, No reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


Changed on 10/14/2018

VAERS ID: 333225 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2008-11-07
Onset:2008-11-12
Submitted:2008-11-20
Entered:2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, No reaction on previous exposure to drug

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC 'Split Type': WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=333225&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166