From the 2/18/2021 release of VAERS data:

Found 753 cases where Vaccine is RV5 and Symptom is Intussusception and Appearance Date on/before '2012-04-30'

This is page 11 out of 76

VAERS ID: 278796 (history)   Form: Version 1.0   Age: 0.2   Sex: Female   Location: Louisiana   Vaccinated: 2007-04-04 Onset: 2007-05-15    Days after vaccination: 41 Submitted: 2007-05-17    Days after onset: 2 Entered: 2007-05-17 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 1 LL / IM HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 1 LL / IM PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689C / 1 RL / IM RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / UNK UN / UN Administered by: Private       Purchased by: Public Symptoms: Barium enema, Intussusception, X-ray with contrast upper gastrointestinal tract SMQs:, Gastrointestinal obstruction (narrow) Life Threatening? Yes Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 2 days    Extended hospital stay? No Previous Vaccinations: Other Medications: Axid Current Illness: None Preexisting Conditions: GERD Allergies: Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses. CDC Split Type: Write-up: Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with decreased bowel sounds, non tender. no masses.

VAERS ID: 279032 (history)   Form: Version 1.0   Age: 0.33   Sex: Female   Location: Kentucky   Vaccinated: 2006-11-07 Onset: 2006-11-13    Days after vaccination: 6 Submitted: 2007-05-16    Days after onset: 183 Entered: 2007-05-18    Days after submission: 2 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 2 RL / IM HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 2 LL / IM PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 2 LL / IM RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO Administered by: Private       Purchased by: Public Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 3 days    Extended hospital stay? No Previous Vaccinations: Other Medications: none Current Illness: none Preexisting Conditions: None Allergies: Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2. CDC Split Type: Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.

VAERS ID: 279026 (history)   Form: Version 1.0   Age: 0.27   Sex: Male   Location: Alabama   Vaccinated: 2007-05-08 Onset: 2007-05-13    Days after vaccination: 5 Submitted: 2007-05-19    Days after onset: 6 Entered: 2007-05-19 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 1 LL / IM PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 1 LL / IM RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 MO / PO Administered by: Unknown       Purchased by: Unknown Symptoms: Barium enema, Central venous catheterisation, Colostomy, Diarrhoea, Endotracheal intubation, Enema administration, Intensive care, Intussusception, Lymphocyte count decreased, Mucous stools, Occult blood, Surgery, Vomiting, X-ray SMQs:, Acute pancreatitis (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? Yes Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 4 days    Extended hospital stay? No Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling Other Medications: none Current Illness: none Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth. Allergies: Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring. CDC Split Type: Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.

VAERS ID: 279106 (history)   Form: Version 1.0   Age: 0.4   Sex: Male   Location: Arizona   Vaccinated: 2007-02-27 Onset: 2007-04-20    Days after vaccination: 52 Submitted: 2007-05-18    Days after onset: 28 Entered: 2007-05-21    Days after submission: 3 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2521AA / 2 - / - HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF068AB / 2 - / - IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20240 / 2 - / - PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08678K / 2 - / - RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 2 MO / PO Administered by: Other       Purchased by: Other Symptoms: Intussusception, Surgery SMQs:, Gastrointestinal obstruction (narrow) Life Threatening? Yes Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 4 days    Extended hospital stay? No Previous Vaccinations: Other Medications: Unknown Current Illness: Preexisting Conditions: Unknown PMH: bilat OM approx 10 days prior to admit Allergies: Diagnostic Lab Data: Unknown CDC Split Type: WAES0705USA02715 Write-up: Information has been received from a physician concerning a 6-month-old male who on 05-DEC-2006 and 27-FEB-2007 was vaccinated PO with the first and second doses of Rotateq (lot number not available). On 20-APR-2007, approximately 7 weeks after receiving the second dose, the patient experienced intussusception and was hospitalized. The patient had surgery to correct this and has subsequently recovered. There was no product quality complaint involved. The event was considered to be immediately life-threatening by the reporter. Additional information has been requested. 5/25/07 Received vax records from PCP but did not include vax lot numbers. T/C to PCP office to request info. 5/25/07 received vax records w/lot numbers. VAERS database updated w/same. 6/18/07 Received hospital medical records which reveal patient experienced vomiting x 4 days & crampy abdominal pain. Seen in ER where UGI revealed bowel obstruction. Admitted 4/20-4/24/07. Air contrast enema confirmed IS but could not reduce. Taken to OR for exp lap, small resection w/primary anastomosis & appendectomy. Progressed well & was d/c to home. FINAL DX: Small bowel-small bowel intussusception reduced by exp laparotomy, small bowel resection w/primary anastomosis & appendectomy.

VAERS ID: 279290 (history)   Form: Version 1.0   Age: 0.5   Sex: Male   Location: Texas   Vaccinated: 2007-04-09 Onset: 2007-05-08    Days after vaccination: 29 Submitted: 2007-05-22    Days after onset: 14 Entered: 2007-05-22 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 RL / IM HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 3 LL / IM PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258H / 3 LL / IM RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0022U / 3 MO / PO Administered by: Unknown       Purchased by: Unknown Symptoms: Abdominal distension, Appendicectomy, Barium enema, Decreased appetite, Diarrhoea, Faeces discoloured, Fluid replacement, Full blood count, Intussusception, Metabolic function test, Occult blood positive, Rotavirus test negative, Surgery, Urine analysis, Vomiting SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Dehydration (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, 2 days    Extended hospital stay? No Previous Vaccinations: Other Medications: Current Illness: convalescent of Ear infection and upper respiratory infection Preexisting Conditions: allergic to amoxil medication Allergies: Diagnostic Lab Data: While hospitalized he had a CBC,CMP,Urinalysis,single colon barium enema exam,and the rotavirus exam.Stools were positive for guaiac,rotavirus exam was negative,electrolytes corrected and CBC was within normal range.the impression on the colon barium exam was that there was intussusception colocolic at the level of the hepatic flexure of the colon.The patient underwent surgery and incidental appendectomy. records received 6/5/07-Labs: WBC 19.9. Blood and urine cultures no growth. Barium enema:Intussusception most likely colocolic at the level of hepatic flexure of colon. CDC Split Type: Write-up: Patient vomited 6 times on date of service 05/09/07 and poor appetite.The day before, he vomited 3 times.We administered Phenegran 0.3ml for the vomiting.He was given pedialyte and gatorade at home.He was admitted to the hospital.He was placed on IV fluids.He had one loose stool with a little red color, the day after admission,child was distended.X-Ray suggested Intussusception and barium enema comfirmed it. surgery was done shortly after 06/05/07-records received from facility for DOS 5/9-5/11/07. DX:Intussusception. Dehydration, Left Otitis Media, Upper Respiratory Infection, Vomiting. Surgery:explaratory laporotomy with reduction of intussusception and incidental appendectomy. 48 hours prior to admission had progressive abdominal distention, vomiting and two episode of bloody stools. . Initially admitted for feeding difficulites and fever since previous night. During course of hospitalization developed diarrhea and vomiting and abdominal distention.

VAERS ID: 279315 (history)   Form: Version 1.0   Age: 0.6   Sex: Female   Location: Connecticut   Vaccinated: 2007-03-28 Onset: 2007-05-10    Days after vaccination: 43 Submitted: 2007-05-18    Days after onset: 8 Entered: 2007-05-23    Days after submission: 5 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 LL / IM PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670H / 3 LL / IM RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 2 MO / PO Administered by: Public       Purchased by: Public Symptoms: Barium double contrast, Inappropriate schedule of drug administration, Intussusception, Surgery SMQs:, Gastrointestinal obstruction (narrow), Medication errors (narrow) Life Threatening? Yes Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 3 days    Extended hospital stay? No Previous Vaccinations: Other Medications: none Current Illness: none Preexisting Conditions: none PMH: GERD Allergies: Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful. CDC Split Type: Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.

VAERS ID: 279695 (history)   Form: Version 1.0   Age: 0.3   Sex: Male   Location: New York   Vaccinated: 2007-05-04 Onset: 2007-05-15    Days after vaccination: 11 Submitted: 2007-05-16    Days after onset: 1 Entered: 2007-05-25    Days after submission: 9 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 2 - / IM HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 - / IM PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 2 - / IM RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 2 MO / PO Administered by: Private       Purchased by: Private Symptoms: Abdominal X-ray, Carbon dioxide abnormal, Intussusception, Lethargy, Vomiting, X-ray abnormal SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad) Life Threatening? Yes Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, ? days    Extended hospital stay? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS. CDC Split Type: Write-up: Intussusception with vomiting, lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.

VAERS ID: 279891 (history)   Form: Version 1.0   Age: 0.3   Sex: Female   Location: Texas   Vaccinated: 2007-03-02 Onset: 2007-04-26    Days after vaccination: 55 Submitted: 2007-05-25    Days after onset: 29 Entered: 2007-05-29    Days after submission: 4 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 2 - / - HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 2 - / - IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 2 - / - PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 2 - / - RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 2 MO / PO Administered by: Other       Purchased by: Other Symptoms: Intussusception SMQs:, Gastrointestinal obstruction (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 2 days    Extended hospital stay? No Previous Vaccinations: Other Medications: None Current Illness: Preexisting Conditions: None. PMH: none. NKDA. Allergies: Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reduction. CDC Split Type: WAES0705USA02888 Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.

VAERS ID: 279922 (history)   Form: Version 1.0   Age: 0.2   Sex: Male   Location: California   Vaccinated: 2007-02-27 Onset: 2007-04-16    Days after vaccination: 48 Submitted: 2007-05-29    Days after onset: 43 Entered: 2007-05-30    Days after submission: 1 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 1 UN / IM HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 UN / IM PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691E / 1 UN / IM RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 1 MO / PO Administered by: Private       Purchased by: Unknown Symptoms: Intussusception, Vomiting SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 1 days    Extended hospital stay? No Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: None. PMH: RSV. reflux. NKDA. Allergies: Diagnostic Lab Data: Labs and Diagnostics: ABD X-ray showed non-specific gas pattern with some air fluid levels and several mildly dilated loops of bowel. Intussusception or partial bowel obstruction are not excluded. ABD US showed an appearance consistant with intussusception showing a mass in the right mid and upper abdomen c/w ileocolic intussusception. Therapeutic enema with gastrografin was showed a "probably sucessful reduction of ileocolic IS. Repeat showed no evidence of IS however no reflux into terminal ileum was obtained. ABD X-ray 5/23/2007 WNL. CDC Split Type: Write-up: intussusception on 4-16-07 seen at hospital. admitted for emesis. 06/04/2007 MR received for o/n hospital stay for c/o decreased po, crying, vomiting and blood in diaper. Reduced with Barium enema. DX Intussusception. Repeat ER visit 5/23/07 with c/o diarrhea and decreased appetite. DX: Enteritis.

VAERS ID: 280057 (history)   Form: Version 1.0   Age: 0.5   Sex: Male   Location: California   Vaccinated: 2007-03-13 Onset: 2007-05-16    Days after vaccination: 64 Submitted: 2007-05-30    Days after onset: 14 Entered: 2007-05-30 Vaccin­ation / Manu­facturer Lot / Dose Site / Route DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 3 LL / IM HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 3 RL / IM IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 3 LL / IM PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 3 RL / IM RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 MO / PO Administered by: Unknown       Purchased by: Unknown Symptoms: Intussusception SMQs:, Gastrointestinal obstruction (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 2 days    Extended hospital stay? No Previous Vaccinations: Other Medications: None Current Illness: No Preexisting Conditions: None Allergies: Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic. CDC Split Type: Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.

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