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

Case Details

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VAERS ID: 271978 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: New Jersey  
Vaccinated:2007-01-16
Onset:2007-01-29
   Days after vaccination:13
Submitted: 2007-02-08
   Days after onset:10
Entered: 2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Feeding disorder, Intussusception, Irritability
SMQs:, Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.


VAERS ID: 271991 (history)  
Form: Version 1.0  
Age: 0.52  
Gender: Male  
Location: Illinois  
Vaccinated:2006-12-14
Onset:2007-01-26
   Days after vaccination:43
Submitted: 2007-02-08
   Days after onset:13
Entered: 2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC Split Type: WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


VAERS ID: 272092 (history)  
Form: Version 1.0  
Age: 0.49  
Gender: Male  
Location: Nebraska  
Vaccinated:2006-12-12
Onset:2007-01-10
   Days after vaccination:29
Submitted: 2007-02-02
   Days after onset:23
Entered: 2007-02-12
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2377A / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE709AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0575 / 3 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Intussusception, Ultrasound abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC Split Type:

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.


VAERS ID: 272130 (history)  
Form: Version 1.0  
Age: 0.33  
Gender: Female  
Location: Michigan  
Vaccinated:2007-02-07
Onset:2007-02-10
   Days after vaccination:3
Submitted: 2007-02-12
   Days after onset:2
Entered: 2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Enema administration, Intussusception, Surgery
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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussusception & ascites. Barium enema not successful at reducing ileoileal intussusception.
CDC Split Type:

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


VAERS ID: 272200 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Male  
Location: Texas  
Vaccinated:2006-12-19
Onset:2007-02-09
   Days after vaccination:52
Submitted: 2007-02-13
   Days after onset:4
Entered: 2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Irritability, Laparotomy, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Hypoglycaemia (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC Split Type:

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


VAERS ID: 272372 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Male  
Location: Texas  
Vaccinated:2006-12-06
Onset:2007-01-17
   Days after vaccination:42
Submitted: 2007-02-15
   Days after onset:29
Entered: 2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO74BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF023AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8682D / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Laboratory test, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract
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? No
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: Labs and UGI on hospitalization LABS: Barium enema attempted to reduce intussusception but was unsuccessful. WBC 15.3, alk phos 293, creatinine 0.2, BUN 14. ratio 70.
CDC Split Type:

Write-up: Vomiting on 01-17-07 with subsequent hospitatlization for intussuception requiring surgical intervention. 3/15/07 Received medical records from hospital which reveal patient experienced acute onset irritability, vomiting & bloody diarrhea for 24 hrs prior to admit on 01/17/07. Be enema unsuccessful & patient taken to OR for surgical reduction & appendectomy. Progressed well & was d/c to home on 01/18/07. Final Dx: Intussusception, surgically reduced; appendectomy.


VAERS ID: 272460 (history)  
Form: Version 1.0  
Age: 0.7  
Gender: Male  
Location: Missouri  
Vaccinated:2007-01-03
Onset:2007-02-03
   Days after vaccination:31
Submitted: 2007-02-17
   Days after onset:14
Entered: 2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE992AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Sepsis, Small intestinal anastomosis, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Respiratory failure (broad)

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? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: URI
Preexisting Conditions: Gastroesophageal reflux PMH: GERD, recurrent otitis media w/PE tube placement 12/06. Family hx of asthma.
Allergies:
Diagnostic Lab Data: Abdominal ultrasound on 2/7/2007 demonstrated intussception LABS: +MRSA nasal swab. All blood, urine & stool c/s neg. Wound c/s 2/14 grew abundant pseudamonas & e.coli. Trach c/s 2/20 grew pseudamonas & tenotrophomonas. CT of abd 2/23 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
CDC Split Type:

Write-up: Patient developed GI symptoms (vomiting) on 2/3/2007 (31 days after receiving 3rd Rotateq). Was diagnosed with intussception on 2/7/2007. Suffered perforation of intestine during attempt to reduce by Barium enema, requiring emergent laparotomy and reanastomosis of small bowel. Suffered a 2nd bowel perforation on 2/12/2007. Illness resulted in ICU admission, intubation, probable sepsis. 3/15/07 Received partial medical records from hospital which reveal patient admitted 2/7/07 after experienced +IS s/p perforation x 2 w/OR repair who developed fever, elevated WBC, increasing discomfort & irritability. Returned to OR on 2/15 for transverse colon perforation. FINAL DX: none at present as patient still hospitalized. Peritonitis, either resistant bacteria such as MRSA or fungal were considered likely. T/C to hospital to determine D/C status of patient & to request D/C Summary if available. Patient d/c to home 3/14. No D/C Summary dictated yet. Will request later. 4/10/07 Received D/C summary from hospital which reveals patient admitted from 2/7/07-3/14/07. Admitted w/abdominal pain & emesis x approx 5 days w/lethargy & dehydration. Treated at outlying hospital w/IVF prior to transfer for surgery on 2/7/07 was exp lap w/ileocecectomy w/primary anastomosis; then, lysis of adhesions & repair of transverse colon perforation on 2/12/07. Condition was critical & worsened prior to second surgry w/patient remaining intubated & in PICU. After second surgery & continued IVF, antibiotics & TPN, had gradual improvement & was successfully extubated. Despite treatment, continued to have intermittent fevers & multiple w/ups were done, all were neg for source of infection. Transitioned from TPN to NJ feeds & was transferred to regular peds floor. Gradually, oral feeds were introduced & tolerated & NJ feeds were d/c. Patient had become accustomed to MSO4 pain med & had extensive wean w/ativan & methadone. Bowel function had returned to normal by d/c to home w/f/u w/PCP & surgery. FINAL DX: Intussusception complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


VAERS ID: 272462 (history)  
Form: Version 1.0  
Age: 0.47  
Gender: Female  
Location: Maryland  
Vaccinated:2007-01-24
Onset:2007-02-17
   Days after vaccination:24
Submitted: 2007-02-17
   Days after onset:0
Entered: 2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 - / SC

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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC Split Type:

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.


VAERS ID: 272809 (history)  
Form: Version 1.0  
Age: 0.19  
Gender: Female  
Location: Illinois  
Vaccinated:2007-01-12
Onset:2007-02-15
   Days after vaccination:34
Submitted: 2007-02-21
   Days after onset:6
Entered: 2007-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 - / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0785F / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 1 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Intussusception, X-ray with contrast lower gastrointestinal tract
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: lower GI-showed intussusception and resolved the problem LABS: water soluble contrast lower GI enema successful in reducing ileocecal IS.
CDC Split Type:

Write-up: Had an intussusception reduced by barium enema on 2/16/07-Ileocal intussusception pain began on 2/15/07. 3/1/07 Received medical records from hospital which reveal patient experienced uncontrollable crying & diarrhea for 2 days along with apparent abdominal pain intermittently for several hours prior to ER. Exam revealed abdomen distended & tender. Patient d/c home same day as successful IS reduction to be f/u by PCP.


VAERS ID: 272903 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Male  
Location: Massachusetts  
Vaccinated:2006-09-18
Onset:2006-09-25
   Days after vaccination:7
Submitted: 2007-02-22
   Days after onset:150
Entered: 2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 1 LA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE830AA / 1 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B22930F / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB & abd US revealed midtransverse colon intussusception. Air contrast enema was successful in reducing.
CDC Split Type:

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


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