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This is VAERS ID 274364

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274364
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intuss"usception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested.


Changed on 12/8/2009

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Nasal congestion, Normochromic normocytic anaemia, Pyrexia, Rhinorrhoea, Surgery, Thrombocythaemia, Vomiting, Weight decreased, White blood cell count increased, Platelet count increased, Occult blood positive, Rotavirus test negative

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, un
CDC 'Split Type': (blank) WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intuss"usception, intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 1/5/2010

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Nasal congestion, Normochromic normocytic anaemia, Pyrexia, Rhinorrhoea, Surgery, Thrombocythaemia, Vomiting, Weight decreased, White blood cell count increased, Platelet count increased, Occult blood positive, Rotavirus test negative

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, un
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 8/31/2010

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery, Occult blood positive

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, un
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 1/4/2011

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery, Occult blood positive

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, un unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 4/13/2011

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Nasal congestion, Normochromic normocytic anaemia, Pyrexia, Rhinorrhoea, Surgery, Thrombocythaemia, Vomiting, Weight decreased, White blood cell count increased, Platelet count increased, Occult blood positive, Rotavirus test negative

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 5/13/2011

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Nasal congestion, Normochromic normocytic anaemia, Pyrexia, Rhinorrhoea, Surgery, Thrombocythaemia, Vomiting, Weight decreased, White blood cell count increased, Platelet count increased, Occult blood positive, Rotavirus test negative

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 6/11/2011

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Nasal congestion, Normochromic normocytic anaemia, Pyrexia, Rhinorrhoea, Surgery, Thrombocythaemia, Vomiting, Weight decreased, White blood cell count increased, Platelet count increased, Occult blood positive, Rotavirus test negative

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 5/13/2013

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Nasal congestion, Normochromic normocytic anaemia, Pyrexia, Rhinorrhoea, Surgery, Thrombocythaemia, Vomiting, Weight decreased, White blood cell count increased, Platelet count increased, Occult blood positive, Rotavirus test negative

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 6/14/2014

274364 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Nasal congestion, Normochromic normocytic anaemia, Pyrexia, Rhinorrhoea, Surgery, Thrombocythaemia, Vomiting, Weight decreased, White blood cell count increased, Platelet count increased, Occult blood positive, Rotavirus test negative

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 2/14/2017

274364 Before After
VAERS Form:
Age:0.3 0.34
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Culture urine negative, Haematochezia, Intussusception, Leukocytosis, Mucous stools, Nasal congestion, Normochromic normocytic anaemia, Pyrexia, Rhinorrhoea, Surgery, Thrombocythaemia, Vomiting, Weight decreased, White blood cell count increased, Platelet count increased, Occult blood positive, Rotavirus test negative

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


Changed on 9/14/2017

274364 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Female
Location:North Carolina
Vaccinated:2006-12-29
Onset:2007-03-03
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 1 2 - / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC 'Split Type': WAES0703USA01240

Write-up:Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


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