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This is VAERS ID 274607

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 274607
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-09
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately"life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested.


Changed on 12/8/2009

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-09
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': (blank) WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately"life-threatening immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 1/5/2010

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-09 2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 3/2/2010

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 4/7/2010

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 8/31/2010

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 1/4/2011

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 4/13/2011

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 5/13/2011

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 6/11/2011

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 5/13/2013

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 6/14/2014

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 2/14/2017

VAERS ID: 274607 Before After
VAERS Form:
Age:0.2 0.18
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 5/14/2017

VAERS ID: 274607 Before After
VAERS Form:
Age:0.18
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Surgery, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal oedema, Intestinal mass, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 9/14/2017

VAERS ID: 274607 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 1 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 2/14/2018

VAERS ID: 274607 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 1 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 6/14/2018

VAERS ID: 274607 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 1 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 8/14/2018

VAERS ID: 274607 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 1 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 9/14/2018

VAERS ID: 274607 Before After
VAERS Form:1
Age:0.18
Gender:Female
Location:Unknown
Vaccinated:2007-02-06
Onset:2007-03-10
Submitted:2007-03-22
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 1 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
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 Birth Hx: normal FT birth & pregnancy per ER record.
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC 'Split Type': WAES0703USA03407

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.

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