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This is VAERS ID 283990

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 283990
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Abdominal X-ray

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had"to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''''s intussusception was considered to be immediately life-threatening and an other important me


Changed on 12/8/2009

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': (blank) WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had"to had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''''s patient''s intussusception was considered to be immediately life-threatening and an other important me medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 3/2/2010

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 4/7/2010

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 8/31/2010

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 4/13/2011

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 5/13/2011

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 6/11/2011

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 5/13/2013

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 5/14/2017

VAERS ID: 283990 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, White blood cell count increased, Abdominal X-ray, Waist circumference increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 9/14/2017

VAERS ID: 283990 Before After
VAERS Form:(blank) 1
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Small intestinal resection

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 2/14/2018

VAERS ID: 283990 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Small intestinal resection

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 6/14/2018

VAERS ID: 283990 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Small intestinal resection

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 8/14/2018

VAERS ID: 283990 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Small intestinal resection

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 9/14/2018

VAERS ID: 283990 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Small intestinal resection

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


Changed on 10/14/2018

VAERS ID: 283990 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-06-12
Submitted:2007-07-05
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086B4H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Small intestinal resection

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC 'Split Type': WAES0706USA04746

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.

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