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This is VAERS ID 269030

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 269030
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Z0420 / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Vomiting

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malr
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of h"yperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 wa


Changed on 12/8/2009

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malr
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''''s old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of h"yperbilirubinemia hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 wa was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 3/2/2010

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malr
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 4/7/2010

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malr
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 8/31/2010

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malr
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 12/7/2010

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malr malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 4/13/2011

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 5/13/2011

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 6/11/2011

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 5/13/2013

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 6/14/2014

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 2/14/2017

VAERS ID: 269030 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 9/14/2017

VAERS ID: 269030 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Vomiting, White blood cell count increased

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 2/14/2018

VAERS ID: 269030 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Vomiting, White blood cell count increased

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 6/14/2018

VAERS ID: 269030 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Vomiting, White blood cell count increased

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 8/14/2018

VAERS ID: 269030 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Vomiting, White blood cell count increased

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./


Changed on 9/14/2018

VAERS ID: 269030 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Wisconsin
Vaccinated:2006-10-18
Onset:2006-12-11
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0849F / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Vomiting, White blood cell count increased

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malrotation, no intussusception, and no volvulus.
CDC 'Split Type':

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 was called and an IV was started in the field which caused the child to perk up some. PE was unremarkable with 1 episode of emesis during exam. PE at this time showed voluntary guarding and mild distension. NG tube was placed and patient did well and was d/c''d home after 2 days. Working DX is transient intussusception reduced with contrast enema. Addendum: spoke with office RN/reporter who confirmed final dx. is the same as primary dx.: bilious emesis, probable intussusception and that Rotateq was given, lot # 0849F./

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