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This is VAERS ID 273010

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 273010
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Abdominal X-ray

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae.


Changed on 12/8/2009

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Lethargy, Pyrexia, X-ray abnormal, Abdominal X-ray

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 1/5/2010

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Lethargy, Pyrexia, X-ray abnormal, Abdominal X-ray

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 3/2/2010

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 4/7/2010

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 8/31/2010

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 4/13/2011

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Lethargy, Pyrexia, X-ray abnormal, Abdominal X-ray

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 5/13/2011

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Lethargy, Pyrexia, X-ray abnormal, Abdominal X-ray

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 6/11/2011

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Lethargy, Pyrexia, X-ray abnormal, Abdominal X-ray

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 5/13/2013

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Lethargy, Pyrexia, X-ray abnormal, Abdominal X-ray

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 2/14/2017

VAERS ID: 273010 Before After
VAERS Form:
Age:0.2 0.16
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Lethargy, Pyrexia, X-ray abnormal, Abdominal X-ray

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 9/14/2017

VAERS ID: 273010 Before After
VAERS Form:(blank) 1
Age:0.16
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


Changed on 2/14/2018

VAERS ID: 273010 Before After
VAERS Form:1
Age:0.16
Gender:Male
Location:Mississippi
Vaccinated:2006-12-29
Onset:2007-02-23
Submitted:2007-02-26
Entered:2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC 'Split Type':

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


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