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This is VAERS ID 275896

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

275896
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Blood urine present, Bacteria stool identified

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type':

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rot"ateq (Lot #''''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN


Changed on 12/8/2009

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type': (blank) WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rot"ateq Rotateq (Lot #''''s #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 3/2/2010

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 4/7/2010

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 8/31/2010

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 4/13/2011

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 5/13/2011

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 6/11/2011

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 5/13/2013

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 2/14/2017

275896 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8670K / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Blood urine present, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Pyrexia, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive, Bacteria stool identified, Occult blood positive, Rotavirus test negative, Oral intake reduced

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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff diff. Stool (+) for occult blood. Rotavirus (-). Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced.
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


Changed on 9/14/2017

275896 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-01-09
Onset:2007-02-12
Submitted:2007-04-09
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 3 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8670K / 2 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Intussusception, Pyrexia, Surgery, 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: 34     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff. Stool (+) for occult blood. Rotavirus (-). Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced.
CDC 'Split Type': WAES0703USA05645

Write-up:Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


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