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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: 274937 (history)  
Form: Version 1.0  
Age: 0.51  
Gender: Female  
Location: Unknown  
Vaccinated:2007-01-31
Onset:2007-02-27
   Days after vaccination:27
Submitted: 2007-03-26
   Days after onset:26
Entered: 2007-03-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Enema administration, Intestinal resection, Intussusception, Surgery
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK LABS: abdominal x-ray revealed SBO. Barium enema revealed IS in mid transverse colon, not completely reduced. US of abdomen + for IS. H/H 10.1/29.0, plts 485, neutros 52.2, lymphs 44.8, monos 2.6. Cl 97, anion gap 19, ca 10.7, creatinine 0.3. Urine sp grav 1.034, ketones 3+
CDC Split Type: WAES0703USA04304

Write-up: Information has been received from a physician concerning a 6 month old female who on 31-JAN-2007 was vaccinated with her last dose of Rotateq (lot #654970/0777F) (the dated of the other two doses were not reported). The patient had no medical history or concomitant therapy. On 27-FEB-2007, the patient was examined by the physician and had developed intussusception. The patient''s symptoms at the time of the exam were reported as unknown. On 01-MAR-2007, the patient was hospitalized for intussusception. An enema reduction was attempted unsuccessfully. The patient had bowel resection surgery. On an unspecified date, the patient recovered from intussusception. Her release date from the hospital was not known. The physician considered intussusception to be immediately life-threatening, and disabling, and an other important medical event. There was no product quality complaint involved. Additional information has been requested. 4/13/07 Received medical records & vax records from PCP which reveal child was in good health on day of vax 1/31/07. Growth & development were as expected for age. Lot # for 3rd dose of Rotateq incorrect on VAERS report & corrected in database. 4/27/07 Received medical records from hospital which reveal patient experienced bilious vomiting, lethargy, fever & dehydration x 2 days prior to admit on 3/1/07-3/5/07. Exam revealed tachycardia, decreased bowel sounds & guarding. Rad attempts at reducing IS were unsuccessful & taken to OR for exp lap, reduction of IS & small bowel resection w/primary anastomosis. Developed post op ileus which resolved. Slowed advanced diet & had maroon stools initially. D/c to home. FINAL DX: ileoileal intussusception, surgically reduced & small bowel resection.


VAERS ID: 275291 (history)  
Form: Version 1.0  
Age: 0.23  
Gender: Female  
Location: Michigan  
Vaccinated:2007-01-15
Onset:2007-03-12
   Days after vaccination:56
Submitted: 2007-03-30
   Days after onset:18
Entered: 2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE972AA / UNK LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / UNK RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Crying, Enema administration, Faeces hard, Haematochezia, Intussusception, Surgery, X-ray
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (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), Depression (excl suicide and self injury) (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC Split Type:

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.


VAERS ID: 275361 (history)  
Form: Version 1.0  
Age: 0.36  
Gender: Female  
Location: Unknown  
Vaccinated:2007-01-30
Onset:2007-03-23
   Days after vaccination:52
Submitted: 2007-03-30
   Days after onset:7
Entered: 2007-04-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC14B040CA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0407F / 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0456 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670K / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 2 UN / -

Administered by: Other       Purchased by: Other
Symptoms: Barium double contrast, 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, 1 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hospitalization x 2 for RSV 12/06 & 1/07. several episodes of apnea. GERD. premature at 35 wks via c-section. Mother had problems w/prior pregnancies & required steroid injections for spontaneous prior abortions. ALLERGY to lactose.
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 19.5. US + for IS. Barium air contrast enema.
CDC Split Type: WAES0703USA05137

Write-up: Information has been received from a physician concerning a 6 month old female who on 24-NOV-2006 was vaccinated with her first dose of Rotateq (LOT # not provided). On 30-JAN-2007, she was vaccinated with her second dose of Rotateq (LOT # not provided). On 23-MAR-2007, the patient developed intussusception and was hospitalized. An air contrast enema was performed. Subsequently, the patient recovered from intussusception. The patient sought unspecified medical attention. There was no product quality complaint involved. Additional information has been requested. 4/17/07 Received medical records from hospital which reveal patient experienced fever, fussiness, bloody stools & projectile vomiting. Had recently been treated for otitis media, was awaiting ear tube placement & had yeast infection. Temp on admit was 103.3 RUQ palpable mass noted w/guarding. Admitted 3/24-3/25/07 for observation s/p barium air contrast enema successful reduction of IS. FINAL DX: Intussusception, reduced by barium air contrast enema.


VAERS ID: 275606 (history)  
Form: Version 1.0  
Age: 0.51  
Gender: Female  
Location: California  
Vaccinated:2006-11-14
Onset:2007-03-16
   Days after vaccination:122
Submitted: 2007-04-04
   Days after onset:19
Entered: 2007-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8658B / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0776F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan abnormal
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), 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: no records received 4/24/07- Slight fever, mild congestion, cough and slight drainage from right eye over past 2 days.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: ultrasound showed intussesception records received 4/24/07-US abdomen:intussusception. Stool WBC and RBC present.
CDC Split Type:

Write-up: intusseseption 04/24/07-records received from facility for DOS 03/16-03/17/07-DC DX:Intussusception. Admitted for observation after successful reduction of intussesception by air enema. Presented with abdominal pain, bloody stool. Cramping, colicky intermittent. 10 stools in past 24 hours, bloody stools.


VAERS ID: 275635 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Maryland  
Vaccinated:2007-01-23
Onset:2007-02-11
   Days after vaccination:19
Submitted: 2007-04-05
   Days after onset:52
Entered: 2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Surgery
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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC Split Type:

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


VAERS ID: 275807 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: California  
Vaccinated:2007-03-23
Onset:2007-03-28
   Days after vaccination:5
Submitted: 2007-04-09
   Days after onset:12
Entered: 2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1242F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031-2 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bacteria stool identified, Carbon dioxide decreased, Culture stool positive, Gastrointestinal haemorrhage, Haematocrit decreased, Haemoglobin decreased, Heart rate increased, Intensive care, Intestinal resection, Intussusception, Lethargy, Livedo reticularis, Red blood cell count decreased, Surgery, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (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? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None PMH: delivered at term by c-section due to lack of progression. Had been developing normally w/o difficulty.
Allergies:
Diagnostic Lab Data: HR 180-200 on arrival. C. diff positive in stool. RBC 2.47, HBG/HCT 7.6/21.5. CO2 18. LABS: Hgb initially 12g & dropped to 7g w/n 5 hours. Transfused. Acidotic. Rotavirus neg. Multiple pages of lab results received.
CDC Split Type:

Write-up: Pt presented with GI bleed 3 days post vacinnation and became lethergic, mottled, with severe swelling. Pt was taken to the ED on 03/28. He was later found with acute intussusception and bowel was resected. Currently in PICU. 5/15/07 Received medical records from hospital which reveal patient experienced fussiness, bloody stools & massive GI bleed. Initially seen at outlying ER where patient found to be in shock & transferred to higher level of care. Admitted from 3/28-5/3/07. Pulses & perfusion were extremely poor, he was tachycardic, poor urine output & he was cold & mottled. Surgical consult done, central line placed & patient transfused. Taken to OR on 4/3/07 where found ischemia & infarction of small bowel. Resection of jejunum done; leaving only approx 30 cm jejunum. Proximal jejunostomy created w/ileostomy & mucous fistula performed using approx 15 cm of terminal ileum. Started on TPN & very slowly built up to 5 mL/TID at d/c oral feeding. Treated w/multiple antibiotics while hospitalized & developed c. difficile. Continued on TPN at d/c w/Home Health follow up due to high output jejunostomy. FINAL DX: ischemia & infarction of small bowel; resection of small bowel w/creation of jejunostomy.


VAERS ID: 275896 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Unknown  
Vaccinated:2007-01-09
Onset:2007-02-12
   Days after vaccination:34
Submitted: 2007-04-09
   Days after onset:55
Entered: 2007-04-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 3 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8670K / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Intussusception, Pyrexia, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff. Stool (+) for occult blood. Rotavirus (-). Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced.
CDC Split Type: WAES0703USA05645

Write-up: Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


VAERS ID: 275949 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Indiana  
Vaccinated:2007-02-16
Onset:2007-04-09
   Days after vaccination:52
Submitted: 2007-04-10
   Days after onset:1
Entered: 2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (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? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC Split Type:

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


VAERS ID: 276038 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2007-01-15
Onset:2007-01-21
   Days after vaccination:6
Submitted: 2007-04-11
   Days after onset:79
Entered: 2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059DA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0719R / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: 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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: x ray etc. LABS: Abdominal US revealed IS. Air contrast barium enema failed x 4.
CDC Split Type:

Write-up: intussusception diagnosed & operated 6 days later. 4/24/07 Received medical records from hospital which reveal patient experienced a 1 day hx of bloody stools & emesis with decreased appetite. Had been transferred from outlying hospital. Admitted1/21/07-1/25/07. Surg consult done & taken to OR for exp lap & ileocecectomy w/primary anastomosis. During surgery there was diffuse purulent fluid found in peritoneum w/necrotic IS. Patient progressed well & was d/c to home FINAL DX: Intussusception, surgically reduced.


VAERS ID: 276539 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Vermont  
Vaccinated:2007-02-01
Onset:2007-04-08
   Days after vaccination:66
Submitted: 2007-04-10
   Days after onset:2
Entered: 2007-04-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Explorative laparotomy, Intussusception, Surgery
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC Split Type:

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


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