|
VAERS ID: |
394334 (history) |
Form: |
Version 1.0 |
Age: |
0.37 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: | 2010-07-15 |
Onset: | 2010-08-01 |
Days after vaccination: | 17 |
Submitted: |
2010-08-04 |
Days after onset: | 3 |
Entered: |
2010-08-05 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3622AA / 3 |
LL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
E49136 / 1 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0176Y / 3 |
MO / PO |
Administered by: Private Purchased by: Public Symptoms: Intussusception 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, 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: Intussusception. |
|
VAERS ID: |
394401 (history) |
Form: |
Version 1.0 |
Age: |
0.17 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 2010-07-20 |
Onset: | 2010-07-29 |
Days after vaccination: | 9 |
Submitted: |
2010-08-05 |
Days after onset: | 7 |
Entered: |
2010-08-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B187AA / 1 |
LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF707AB / 1 |
LL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
E49136 / 1 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1524Y / 1 |
MO / PO |
Administered by: Private Purchased by: Public Symptoms: Abdominal pain,
Barium enema,
Intussusception,
Irritability SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Barium enema on 7.31.2010 CDC Split Type:
Write-up: Irritability and abdominal cramps developed 7.29.2010 or 7.30.2010. Intussusception diagnosed 7.31.2010 at hospital. |
|
VAERS ID: |
394758 (history) |
Form: |
Version 1.0 |
Age: |
0.21 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 2010-07-30 |
Onset: | 2010-08-05 |
Days after vaccination: | 6 |
Submitted: |
2010-08-10 |
Days after onset: | 5 |
Entered: |
2010-08-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C684AA / 1 |
LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
E69009 / 1 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0687Z / 1 |
MO / PO |
Administered by: Private Purchased by: Other Symptoms: Enema administration,
Hyperhidrosis,
Intussusception,
Irritability,
Occult blood positive,
Pallor,
Staring,
Ultrasound abdomen abnormal SMQs:, Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (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, 6 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: No Preexisting Conditions: None Allergies: Diagnostic Lab Data: Heme positive stools Intussusception on U/S CDC Split Type:
Write-up: Diaphoresis, pallor, staring spells, fussiness. Admitted to hospital where he was eventually diagnosed with intussusception. This was successfully corrected with air enema, confirmed by ultrasound. |
|
VAERS ID: |
395468 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
New York |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
2010-08-13 |
Entered: |
2010-08-16 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
- / 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? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Unknown Current Illness: Preexisting Conditions: Unknown Allergies: Diagnostic Lab Data: Unknown CDC Split Type: WAES1008USA01103
Write-up: Information has been received concerning a patient who on an unspecified date was vaccinated with the second dose of series ROTATEQ, oral. It was reported that the patient from a physician''s office received two doses of ROTATEQ and then experienced intussusception. No further information is available at this time of reporting. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. |
|
VAERS ID: |
395889 (history) |
Form: |
Version 1.0 |
Age: |
0.21 |
Sex: |
Female |
Location: |
Kentucky |
Vaccinated: | 2010-07-22 |
Onset: | 2010-08-12 |
Days after vaccination: | 21 |
Submitted: |
2010-08-16 |
Days after onset: | 4 |
Entered: |
2010-08-19 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3529AA / 1 |
LL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
E45350 / 1 |
RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0500Z / 1 |
MO / PO |
Administered by: Private Purchased by: Public Symptoms: Intussusception,
Laboratory test,
X-ray 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, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: See attached hospital records, labs, and radiographic studies. CDC Split Type:
Write-up: Patient diagnosed with intussusception to hepatic flexure on 8/12/10 (3 months of age). On 7/22/10, she was given ROTATEQ, (DTaP, Hib, and IVP=$gPENTACEL), and PREVNAR. |
|
VAERS ID: |
396182 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
California |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
2010-08-20 |
Entered: |
2010-08-23 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
- / 2 |
UN / UN |
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Unknown Current Illness: Preexisting Conditions: Unknown Allergies: Diagnostic Lab Data: Unknown CDC Split Type: WAES1008USA01797
Write-up: Information has been received from a physician concerning a baby boy who was vaccinated with a second dose of ROTATEQ (Lot number unknown) and one month after receiving it, he experienced intussusception. At the time of report, the patient had recovered from intussusception. Upon internal review, intussusception was considering to be an other important medical event. Additional information has been requested. |
|
VAERS ID: |
396646 (history) |
Form: |
Version 1.0 |
Age: |
0.34 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 2010-08-09 |
Onset: | 2010-08-25 |
Days after vaccination: | 16 |
Submitted: |
2010-08-26 |
Days after onset: | 1 |
Entered: |
2010-08-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B248CA / 2 |
LL / IJ |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UO090AB / 2 |
RL / IJ |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
E51167 / 2 |
RL / IJ |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0200Z / UNK |
MO / PO |
Administered by: Private Purchased by: Public Symptoms: Enema administration,
Intussusception,
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, 1 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: None Current Illness: Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Dx: Small bowel intussusception. Treatment: Reduced with an air enema. Signs/Symptoms: Went to hospital with vomiting. |
|
VAERS ID: |
396931 (history) |
Form: |
Version 1.0 |
Age: |
0.22 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 2010-07-22 |
Onset: | 2010-08-14 |
Days after vaccination: | 23 |
Submitted: |
2010-08-20 |
Days after onset: | 6 |
Entered: |
2010-08-31 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3625AC / 1 |
RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
E51167 / 1 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0500Z / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Abdominal pain,
Haematochezia,
Intussusception,
Irritability,
Surgery SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), 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? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Intussusception CDC Split Type:
Write-up: Rotavirus given 7/22/10. 8/14/10 fussiness/abd pain, bloody stool. Transferred to tertiary care for intussusception. Reduced surgically. |
|
VAERS ID: |
397080 (history) |
Form: |
Version 1.0 |
Age: |
0.23 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 2010-08-25 |
Onset: | 2010-08-25 |
Days after vaccination: | 0 |
Submitted: |
2010-08-27 |
Days after onset: | 2 |
Entered: |
2010-09-01 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3745AA / 1 |
LA / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
E71440 / 1 |
RA / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0512Z / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Enema administration,
Haematochezia,
Intussusception,
Irritability,
Ultrasound abdomen abnormal SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ischaemic colitis (broad), Hypoglycaemia (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, 0 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: GERD Allergies: Diagnostic Lab Data: Ultrasound of abdomen; Air enema -$g corrected the intussusception CDC Split Type:
Write-up: Patient started with extreme irritability after receiving her first DAPT-IPV-HIB, PREVNAR, and rotavirus vaccines. Sx''s started the night of the administration and had a current jelly stool the next day - Ultrasound showed intussusception. |
|
VAERS ID: |
397748 (history) |
Form: |
Version 1.0 |
Age: |
0.51 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 2010-08-09 |
Onset: | 2010-08-15 |
Days after vaccination: | 6 |
Submitted: |
2010-08-20 |
Days after onset: | 5 |
Entered: |
2010-09-08 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3681AB / 3 |
LL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
E72960 / 3 |
RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0510Z / 3 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Haematochezia,
Intussusception,
Lethargy,
Pain,
Surgery,
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), Ischaemic colitis (broad), Hypoglycaemia (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: No Current Illness: No Preexisting Conditions: No Allergies: Diagnostic Lab Data: As above CDC Split Type:
Write-up: Child received ROTATEQ Aug. 9, 2010. On 15th - pain - lethargy - vomiting, bloody stool - intussusception - needed open reduction. |
|