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This is VAERS ID 275949

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 275949
VAERS Form:
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Colostomy, Diarrhoea haemorrhagic, Gastrointestinal necrosis, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association.


Changed on 12/8/2009

VAERS ID: 275949 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium double contrast, Colostomy, Diarrhoea haemorrhagic, Gastrointestinal necrosis, Intussusception, Laparotomy, Mucous stools

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 3/2/2010

VAERS ID: 275949 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08646F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Colostomy, Diarrhoea haemorrhagic, Gastrointestinal necrosis, Intussusception, Laparotomy, Mucous stools

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 4/7/2010

VAERS ID: 275949 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Colostomy, Diarrhoea haemorrhagic, Gastrointestinal necrosis, Intussusception, Laparotomy, Mucous stools

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 8/31/2010

VAERS ID: 275949 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08646F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Colostomy, Diarrhoea haemorrhagic, Gastrointestinal necrosis, Intussusception, Laparotomy, Mucous stools

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 5/13/2013

VAERS ID: 275949 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Colostomy, Diarrhoea haemorrhagic, Gastrointestinal necrosis, Intussusception, Laparotomy, Mucous stools

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 5/14/2017

VAERS ID: 275949 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Colostomy, Diarrhoea haemorrhagic, Gastrointestinal necrosis, Intussusception, Laparotomy, Mucous stools

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 9/14/2017

VAERS ID: 275949 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 2/14/2018

VAERS ID: 275949 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 6/14/2018

VAERS ID: 275949 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 8/14/2018

VAERS ID: 275949 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.


Changed on 9/14/2018

VAERS ID: 275949 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Indiana
Vaccinated:2007-02-16
Onset:2007-04-09
Submitted:2007-04-10
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC 'Split Type':

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy.

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