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This is VAERS ID 262993

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 262993
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (UNKNOWN MFR) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Y1051 / 1 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08655E / 1 RA / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileo
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diap"er today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/:


Changed on 12/8/2009

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (UNKNOWN MFR) DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08655E / 1 RA / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileo
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diap"er diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 1/5/2010

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08655E / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileo
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 3/2/2010

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08655E / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileo
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 4/7/2010

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08655E / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileo
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 8/31/2010

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08655E / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileo
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 1/4/2011

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileo ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 5/13/2013

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 6/14/2014

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 2/14/2017

VAERS ID: 262993 Before After
VAERS Form:
Age:0.4 0.41
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 9/14/2017

VAERS ID: 262993 Before After
VAERS Form:(blank) 1
Age:0.41
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 1 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 1 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 1 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UNK - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 2/14/2018

VAERS ID: 262993 Before After
VAERS Form:1
Age:0.41
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / UNK MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 6/14/2018

VAERS ID: 262993 Before After
VAERS Form:1
Age:0.41
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / UNK MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 8/14/2018

VAERS ID: 262993 Before After
VAERS Form:1
Age:0.41
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / UNK MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.


Changed on 9/14/2018

VAERS ID: 262993 Before After
VAERS Form:1
Age:0.41
Gender:Male
Location:Texas
Vaccinated:2006-08-04
Onset:2006-09-05
Submitted:2006-09-13
Entered:2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 03897 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE812AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1051 / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / UNK MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileocolic intussusception. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes.
CDC 'Split Type':

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diaper today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/: Ileo ileocolic intussusception. Procedure: open reduction of intussusception. Incidental appendectomy. Preoperative Note: admitted to hospital with bilious emesis approximately 36 hours ago. Upper GI normal, US failed to disclose a suspected intussusception. Underwent trial of feeds which were unsuccessful. Follow up CT scan disclosed intussusception in right lower quadrant which was masked by overlying small bowel. Open reduction recommended due to failure of hydrostatic reduction in radiology. HX of Present Illness: admitted 9/5/06 with emesis which progressed to bilious and fussiness and dry heaves. Seen in office after 2 hours of emesis and a normal BM. No diarrhea and no fever. PMH: Bronchitis. PE: Temp 99.5, HR 131, resp rate 32. Slightly lethargic, dry lips and mucous membranes. Mild tachycardia. Lungs clear. ABD: very supple without guarding, soft, nontender and nondistended. Normal bowel sounds. 2 trials of feeds failed with bilious emesis and started to have mucosy bloody stools. Attempted hydrostatic reduction was unsuccessful. Surgery 9/7/06 open reduction and intussusception and internal appendectomy. He did not require a bowel resection. Uncomplicated postoperative course with gradual resumption of p.o. feeds. Post op day #3 tolerating goal calorie and fluid diet. Afebrile, vital signs stable. DC to home follow up in 3-4 weeks.

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