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This is VAERS ID 269503

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269503
VAERS Form:
Age:0.4
Gender:Female
Location:Arizona
Vaccinated:2006-12-08
Onset:2006-12-20
Submitted:2006-12-21
Entered:2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Y1031 / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES 806681F / 1 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Intussusception, Lethargy, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out"malrotation.


Changed on 12/8/2009

269503 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arizona
Vaccinated:2006-12-08
Onset:2006-12-20
Submitted:2006-12-21
Entered:2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. SANOFI PASTEUR C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. SANOFI PASTEUR UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. SANOFI PASTEUR Y1031 / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC 806681F / 1 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema LABS: US of abd revealed intussusception. BE successfully reduced. UGI w/ small bowel f/t showed normal anatomy.
CDC 'Split Type':

Write-up:Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''''s Patient''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out"malrotation. out malrotation. 2/5/07 Received medical records from hospital which reveal patient experienced vomiting & lethargy for 5 days & was admitted to hospital 12/20/06-12/21/06. Exam revealed patient was dehydrated. IS was suspected, successfully reduced & patient was admitted for overnight observation s/p reduction due to possibility of malrotation or mobile cecum. Ped surgery consult done FINAL DX: Intussusception, reduced by BE.


Changed on 3/2/2010

269503 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arizona
Vaccinated:2006-12-08
Onset:2006-12-20
Submitted:2006-12-21
Entered:2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 806681F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema LABS: US of abd revealed intussusception. BE successfully reduced. UGI w/ small bowel f/t showed normal anatomy.
CDC 'Split Type':

Write-up:Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out malrotation. 2/5/07 Received medical records from hospital which reveal patient experienced vomiting & lethargy for 5 days & was admitted to hospital 12/20/06-12/21/06. Exam revealed patient was dehydrated. IS was suspected, successfully reduced & patient was admitted for overnight observation s/p reduction due to possibility of malrotation or mobile cecum. Ped surgery consult done FINAL DX: Intussusception, reduced by BE.


Changed on 4/7/2010

269503 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arizona
Vaccinated:2006-12-08
Onset:2006-12-20
Submitted:2006-12-21
Entered:2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 806681F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema LABS: US of abd revealed intussusception. BE successfully reduced. UGI w/ small bowel f/t showed normal anatomy.
CDC 'Split Type':

Write-up:Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out malrotation. 2/5/07 Received medical records from hospital which reveal patient experienced vomiting & lethargy for 5 days & was admitted to hospital 12/20/06-12/21/06. Exam revealed patient was dehydrated. IS was suspected, successfully reduced & patient was admitted for overnight observation s/p reduction due to possibility of malrotation or mobile cecum. Ped surgery consult done FINAL DX: Intussusception, reduced by BE.


Changed on 8/31/2010

269503 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arizona
Vaccinated:2006-12-08
Onset:2006-12-20
Submitted:2006-12-21
Entered:2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 806681F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema LABS: US of abd revealed intussusception. BE successfully reduced. UGI w/ small bowel f/t showed normal anatomy.
CDC 'Split Type':

Write-up:Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out malrotation. 2/5/07 Received medical records from hospital which reveal patient experienced vomiting & lethargy for 5 days & was admitted to hospital 12/20/06-12/21/06. Exam revealed patient was dehydrated. IS was suspected, successfully reduced & patient was admitted for overnight observation s/p reduction due to possibility of malrotation or mobile cecum. Ped surgery consult done FINAL DX: Intussusception, reduced by BE.


Changed on 5/13/2013

269503 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arizona
Vaccinated:2006-12-08
Onset:2006-12-20
Submitted:2006-12-21
Entered:2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 806681F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema LABS: US of abd revealed intussusception. BE successfully reduced. UGI w/ small bowel f/t showed normal anatomy.
CDC 'Split Type':

Write-up:Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out malrotation. 2/5/07 Received medical records from hospital which reveal patient experienced vomiting & lethargy for 5 days & was admitted to hospital 12/20/06-12/21/06. Exam revealed patient was dehydrated. IS was suspected, successfully reduced & patient was admitted for overnight observation s/p reduction due to possibility of malrotation or mobile cecum. Ped surgery consult done FINAL DX: Intussusception, reduced by BE.


Changed on 2/14/2017

269503 Before After
VAERS Form:
Age:0.4 0.35
Gender:Female
Location:Arizona
Vaccinated:2006-12-08
Onset:2006-12-20
Submitted:2006-12-21
Entered:2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 806681F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Intussusception, Lethargy, Vomiting, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema LABS: US of abd revealed intussusception. BE successfully reduced. UGI w/ small bowel f/t showed normal anatomy.
CDC 'Split Type':

Write-up:Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out malrotation. 2/5/07 Received medical records from hospital which reveal patient experienced vomiting & lethargy for 5 days & was admitted to hospital 12/20/06-12/21/06. Exam revealed patient was dehydrated. IS was suspected, successfully reduced & patient was admitted for overnight observation s/p reduction due to possibility of malrotation or mobile cecum. Ped surgery consult done FINAL DX: Intussusception, reduced by BE.


Changed on 9/14/2017

269503 Before After
VAERS Form:(blank) 1
Age:0.35
Gender:Female
Location:Arizona
Vaccinated:2006-12-08
Onset:2006-12-20
Submitted:2006-12-21
Entered:2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 806681F / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema LABS: US of abd revealed intussusception. BE successfully reduced. UGI w/ small bowel f/t showed normal anatomy.
CDC 'Split Type':

Write-up:Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out malrotation. 2/5/07 Received medical records from hospital which reveal patient experienced vomiting & lethargy for 5 days & was admitted to hospital 12/20/06-12/21/06. Exam revealed patient was dehydrated. IS was suspected, successfully reduced & patient was admitted for overnight observation s/p reduction due to possibility of malrotation or mobile cecum. Ped surgery consult done FINAL DX: Intussusception, reduced by BE.


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