|
VAERS ID: |
311702 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 2008-04-11 |
Onset: | 2008-04-18 |
Days after vaccination: | 7 |
Submitted: |
2008-04-29 |
Days after onset: | 11 |
Entered: |
2008-05-06 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B024AA / 3 |
UN / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF233AA / 3 |
UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
C57539 / 3 |
UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0275X / 3 |
MO / PO |
Administered by: Private Purchased by: Private 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? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt diagnosed with intussusception on 4/18/08. Required surgical reduction. |
|
VAERS ID: |
311823 (history) |
Form: |
Version 1.0 |
Age: |
0.54 |
Sex: |
Female |
Location: |
Kentucky |
Vaccinated: | 2008-02-14 |
Onset: | 2008-02-25 |
Days after vaccination: | 11 |
Submitted: |
2008-05-07 |
Days after onset: | 71 |
Entered: |
2008-05-07 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
ACZIBI37AA / 2 |
RL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF328AA / 2 |
LL / ID |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B54015D / 2 |
LL / ID |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0902U / 2 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Enema administration,
Intussusception,
X-ray abnormal 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, 1 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: x-ray consistent with intussiception 7/30/08-records received- Air contrast enema with successful reduction of ileocolic intussusception at level of hepatic flexure of colon. X-ray abdomen soft tissue mass in right upper quadrant . CDC Split Type:
Write-up: Patient developed intussusception on 2/25/08. Reduced with air contrast b.e. same day. 7/30/08-records received for DOS 2/26/08 DX:Intussusception. Presented with colicky abdominal pain. Heme positive stools, 15-20 episodes of emesis last one streaked with blood and yellow color bilious emesis. Normal BM earlier in day then loose BM at 1700. |
|
VAERS ID: |
311829 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: | 2007-12-17 |
Onset: | 2008-05-05 |
Days after vaccination: | 140 |
Submitted: |
2008-05-07 |
Days after onset: | 2 |
Entered: |
2008-05-07 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B128AB / 3 |
LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF192AA / 3 |
LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
854013C / 3 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1392U / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Abdominal X-ray,
Abdominal pain,
Barium double contrast,
Crying,
Enema administration,
Intussusception,
X-ray abnormal SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad)
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, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: none Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit. Preexisting Conditions: none Allergies: Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS. CDC Split Type:
Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home. |
|
VAERS ID: |
311843 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 2008-04-04 |
Onset: | 2008-04-23 |
Days after vaccination: | 19 |
Submitted: |
2008-05-05 |
Days after onset: | 12 |
Entered: |
2008-05-08 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B142AA / 2 |
LL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
C49920 / 2 |
RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1394U / 2 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Barium double contrast,
Blood culture negative,
Intussusception,
Urinary system X-ray SMQs:, Gastrointestinal obstruction (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, 1 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: none Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes decreased 35, blood culture no growth. CDC Split Type:
Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output. |
|
VAERS ID: |
311903 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Nebraska |
Vaccinated: | 2008-05-01 |
Onset: | 2008-05-07 |
Days after vaccination: | 6 |
Submitted: |
2008-05-08 |
Days after onset: | 1 |
Entered: |
2008-05-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR |
C2799AA / 3 |
LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF230AB / 3 |
RL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR |
AO342-2 / 3 |
LL / SC |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
C54766 / 5 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1108U / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Abdominal pain,
Barium enema,
Enema administration,
Haematochezia,
Intussusception,
Mucous stools,
Surgery,
Vomiting SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), 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, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: None. Allergies: Diagnostic Lab Data: 5/8/08: Two separate barium enema studies confirmed intussusception, unable to reduce in radiology. Labs and Diagnostics: BE (+) for ileocolonic IS. CDC Split Type:
Write-up: Vomiting and abdominal pain began on 5/7. Also had bloody, mucousy stool. Admitted to hospital and barium enema confirmed intussusception. Transferred to Hospital in early AM of 5/8/08. Repeat barium enema confirmed diagnosis, but unable to reduce completely. Surgical reduction performed on 5/8/08. At time of this report, patient recovering in hospital. 5/15/2008 MR received for DOS 5/8-10/2008 with D/C DX: S/P Intussusception reduction. Infant presented to ER with c/o nausea, vomiting, bloody bowel movements and cramping and abdominal pain. PE (+) for pallor and a 2x2cm abdominal mass in the R abdomen. Reduction attempted by Barium Enema x 2 at local hospital but unsuccessful at reduction. BE at current facility also unsuccessful x 3 attempts. Pt taken to OR for Exploratory Lap with IS reduction and appendectomy. Pt developed fever 1 day post-op but was D/C on POD#2 |
|
VAERS ID: |
312127 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 2008-03-11 |
Onset: | 2008-04-04 |
Days after vaccination: | 24 |
Submitted: |
2008-05-12 |
Days after onset: | 38 |
Entered: |
2008-05-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C2935AA / 2 |
LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF355AA / 2 |
RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
A0170-2 / 2 |
LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B47442H / 2 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0968U / 1 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Appendicectomy,
Intussusception,
Surgery,
Vomiting SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 6 days
Extended hospital stay? Yes
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: 9/11/08-records received-Abdominal x-ray consistent with intussusception. Air contrast enema revealed obstruction at left side of bowel. Incomplete reduction by air contrast enema. two episodes of bilious emesis on 4/9/08. Abdominal US and x-ray and barium enema did not revealed repeat intussusception. CDC Split Type:
Write-up: 4/4/08 Patient started having vomiting with every feeds. Initially diagnosed as gastroenteritis. Went to Emergency Dept 4/4/08, 4/6/08, and our office 4/7/08. Diagnosed with intussucsception 4/8/08. Unable to be reduced by radiology, and required surgery. Had surgery for intussusception 4/8/08 and appendectomy. 9/11/08-records received for DOS 4/8-4/14/08-DC DX:Intussusception status post reduction and appendectomy. Presented with 4 day history of vomiting after every feeding, crying and increased fussiness. Post operatively had increased distention and had NG tube placement after two episodes of bilious emesis on 4/9/08. Abdominal US and x-ray and barium enema did not revealed repeat intussusception. NG removed tolerating fluids. |
|
VAERS ID: |
312299 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 2008-03-19 |
Onset: | 2008-04-27 |
Days after vaccination: | 39 |
Submitted: |
2008-05-07 |
Days after onset: | 10 |
Entered: |
2008-05-14 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C2800AA / 3 |
UN / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF231AA / 3 |
UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
C49917 / 3 |
UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1734U / 3 |
MO / PO |
Administered by: Private 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, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: None PMH: recurrent OM x 4 Allergies: Diagnostic Lab Data: Abdominal US/X-ray LABS: Abdominal x-ray & US c/w ileocolic IS. CDC Split Type:
Write-up: Intussusception 4/29/08 6/20/08 Reviewed hospital medical records of 4/29-5/1/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced restlessness, cramping intermittent abdominal pain, bilious emesis, constipation x 3-4 days. Air contrast enema was initially successful then IS recurred overnight. BE then was unsuccessful & taken to OR for laparoscopy. Improved & d/c to home on oral antibiotics for recent OM. |
|
VAERS ID: |
312391 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
Oregon |
Vaccinated: | 2007-12-18 |
Onset: | 2008-05-08 |
Days after vaccination: | 142 |
Submitted: |
2008-05-15 |
Days after onset: | 7 |
Entered: |
2008-05-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C2765AA / 3 |
LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
A0169 / 3 |
LL / SC |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
C45888 / 3 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0903U / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Blood test,
Diarrhoea,
Haematochezia,
Intussusception,
Ultrasound scan,
Vomiting SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: none Current Illness: no Preexisting Conditions: no Allergies: Diagnostic Lab Data: ultrasound for diagnosis and xrays before and after and rountine blood work 6/20/08-records received- Stool quaiac positive and KUB showed possibly gas in right side of abdomen.. Ultrasound showed ileocecal intussusception. CDC Split Type:
Write-up: on 5/10/2008 Adnitted to Hospital for vomitting and diarrhea, bloody stools. Abd ultrasound consisitent with Ileocolic Intussusception! Air Reduction Kit utilized and no obstruction and a successdul reduction if the intussusception done. Patient was in the hospital for 4 days 6/20/08-records received for Dos 5/8-5/13/08- DC DX:Ileocecal Intussusception. Therapeutic air contrast enema for reduction was successful. Admitted with nausea and vomiting, on 3rd day of hospitalization episodic crying and attacks of abdominal pain, more vomiting. Abdomen distended. Hypoactive bowel sounds |
|
VAERS ID: |
312427 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Female |
Location: |
South Carolina |
Vaccinated: | 2007-11-06 |
Onset: | 2008-03-10 |
Days after vaccination: | 125 |
Submitted: |
2008-05-15 |
Days after onset: | 66 |
Entered: |
2008-05-16 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B115CB / 3 |
LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B70143H / 3 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1192U / 3 |
MO / PO |
Administered by: Other Purchased by: Other Symptoms: Enema administration,
Gastroenteritis,
Intussusception,
Laboratory test abnormal,
Vomiting,
X-ray abnormal SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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, 4 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: AUGMENTIN Current Illness: Ear infection Preexisting Conditions: Allergies: Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine culture no growth. Urinalysis WNL. KUB:one distended small bowel loop. No gas seen over rectum. An early obstruction cannot be excluded. 7/15/08-records received-Abdominal x-ray small bowel distention with minimal colonic gas. Air reduction of mid-transverse colon successful. CDC Split Type: WAES0805USA01055
Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception. |
|
VAERS ID: |
312536 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 2008-03-18 |
Onset: | 2008-04-10 |
Days after vaccination: | 23 |
Submitted: |
2008-05-16 |
Days after onset: | 36 |
Entered: |
2008-05-19 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
- / 3 |
MO / PO |
Administered by: Other Purchased by: Other Symptoms: Barium enema,
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, 0 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Unknown Current Illness: Preexisting Conditions: Unknown Allergies: Diagnostic Lab Data: Unknown CDC Split Type: WAES0805USA01939
Write-up: Information has been received from a nurse concerning a 6 month old male who on 18-MAR-2008 was vaccinated orally with "one tube", a third and final dose of ROTATEQ. On 10-APR-2008 the patient was hospitalized with intussusception. The patient was treated twice with therapeutic barium enema. The patient recovered and was discharged on 13 APR 2008. The patient had two follow up visits "to the office" since discharge, and had no problems. Additional information has been requested. |
|