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This is VAERS ID 412252

History of Changes from the VAERS Wayback Machine

First Appeared on 1/4/2011

VAERS ID: 412252
VAERS Form:
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 5/13/2013

VAERS ID: 412252 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 6/14/2014

VAERS ID: 412252 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 4/14/2017

VAERS ID: 412252 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 9/14/2017

VAERS ID: 412252 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 3 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 2/14/2018

VAERS ID: 412252 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 6/14/2018

VAERS ID: 412252 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 8/14/2018

VAERS ID: 412252 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 9/14/2018

VAERS ID: 412252 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.


Changed on 10/14/2018

VAERS ID: 412252 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2010-12-07
Entered:2010-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 - / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1003USA03950

Write-up: Information has been received from a physician concerning a 30 week old male patient who on an unspecified date when he was 10 weeks old was vaccinated with the first dose of ROTATEQ orally. On an unspecified date, the patient received the third dose of ROTARIX. When the patient was 26 weeks old, he received the second dose of ROTATEQ orally. Subsequently, 32 days after the last vaccination, when he was 30 weeks old, the patient experienced intussusception. At the time of the report the patient''s outcome was unknown. Upon internal review intussusception was considered to be an other important medical event. This is an amended report. The narrative was updated. The patient received the third dose of ROTARIX (vaccines dose and series was unspecified). No further information is available.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=412252&WAYBACKHISTORY=ON


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