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This is VAERS ID 278006

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 278006
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / - LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Full blood count normal, Haematochezia, Inappropriate schedule of drug administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools,"abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 12/8/2009

VAERS ID: 278006 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / - LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Barium enema, Full blood count normal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools,"abdominal stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 278006 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / - LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 2 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08646C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Full blood count normal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 278006 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / - LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 2 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Full blood count normal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 8/31/2010

VAERS ID: 278006 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / - LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08646C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Full blood count normal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 278006 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / - LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Full blood count normal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 5/14/2017

VAERS ID: 278006 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / - LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 2 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Full blood count normal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Vomiting, Ultrasound abdomen abnormal, Laboratory test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 278006 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / - UNK LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 2 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 2 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 2 3 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 278006 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / UNK LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 3 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 6/14/2018

VAERS ID: 278006 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / UNK LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 3 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 8/14/2018

VAERS ID: 278006 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / UNK LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 3 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.


Changed on 9/14/2018

VAERS ID: 278006 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:California
Vaccinated:2006-12-29
Onset:2007-04-26
Submitted:2007-05-02
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965AB / UNK LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0032F / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AD / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y10312 / 3 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Hospitalized Abdominal US abnormal, barium enema cbc & chemistry both WNL.
CDC 'Split Type':

Write-up: Intussusception 5/15/07 Received vax records from reporter. Lot numbers corrected in VAERS database. RO lot number & dose confirmed by vax records. 5/25/07 Received medical records from hospital which reveal patient experienced emesis, bloody stools, abdominal pain & lethargy. IS at right hepatic flexure diagnosed by abd US & reduced by barium enema. Admitted 4/27 & d/c later same day after observation s/p IS reduction. Consult by peds surgery done. FINAL DX: Intussusception.

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