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This is VAERS ID 274366

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 274366
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), re"spectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was re


Changed on 12/8/2009

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases abnormal, Constipation, Diarrhoea, Differential white blood cell count, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, Pyrexia, Vomiting, Decreased appetite

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': (blank) WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), re"spectively. respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was re reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 1/5/2010

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR - 1110F / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases abnormal, Constipation, Diarrhoea, Differential white blood cell count, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, Pyrexia, Vomiting, Decreased appetite

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 8/31/2010

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Blood gases abnormal, Constipation, Diarrhoea, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 1/4/2011

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Blood gases abnormal, Constipation, Diarrhoea, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 4/13/2011

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases abnormal, Constipation, Diarrhoea, Differential white blood cell count, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, Pyrexia, Vomiting, Decreased appetite

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 5/13/2011

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases abnormal, Constipation, Diarrhoea, Differential white blood cell count, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, Pyrexia, Vomiting, Decreased appetite

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 6/11/2011

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases abnormal, Constipation, Diarrhoea, Differential white blood cell count, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, Pyrexia, Vomiting, Decreased appetite

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 5/13/2013

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases abnormal, Constipation, Diarrhoea, Differential white blood cell count, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, Pyrexia, Vomiting, Decreased appetite

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 2/14/2017

VAERS ID: 274366 Before After
VAERS Form:
Age:0.4 0.42
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / - UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases abnormal, Constipation, Diarrhoea, Differential white blood cell count, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, Pyrexia, Vomiting, Decreased appetite

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 9/14/2017

VAERS ID: 274366 Before After
VAERS Form:(blank) 1
Age:0.42
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / - UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Constipation, Diarrhoea, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 2/14/2018

VAERS ID: 274366 Before After
VAERS Form:1
Age:0.42
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Constipation, Diarrhoea, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 6/14/2018

VAERS ID: 274366 Before After
VAERS Form:1
Age:0.42
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Constipation, Diarrhoea, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


Changed on 8/14/2018

VAERS ID: 274366 Before After
VAERS Form:1
Age:0.42
Gender:Female
Location:New York
Vaccinated:2007-01-17
Onset:2007-03-07
Submitted:2007-03-19
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Constipation, Diarrhoea, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC 'Split Type': WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.

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