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This is VAERS ID 284183

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 284183
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B0876920 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abnormal faeces, Barium enema, Blood culture negative, Culture stool negative

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/2
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included /"other vaccines at the same time./" Subsequently the patient developed an intussusception and was hospitalized. T"he physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to preven

Changed on 12/8/2009

VAERS ID: 284183 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B0876920 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abnormal faeces, Barium enema, Blood culture negative, Culture stool negative, Culture urine negative, Faeces discoloured, Intussusception, Lethargy, Mucosal dryness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Fluid intake reduced, Occult blood positive

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/2
CDC 'Split Type': (blank) WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included /"other "other vaccines at the same time./" time." Subsequently the patient developed an intussusception and was hospitalized. T"he The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to preven prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 3/2/2010

VAERS ID: 284183 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B0876920 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abnormal faeces, Barium enema, Blood culture negative, Culture stool negative, Culture urine negative, Faeces discoloured, Intussusception, Lethargy, Mucosal dryness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Fluid intake reduced, Occult blood positive

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/2
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 4/7/2010

VAERS ID: 284183 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B0876920 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abnormal faeces, Barium enema, Blood culture negative, Culture stool negative, Culture urine negative, Faeces discoloured, Intussusception, Lethargy, Mucosal dryness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Fluid intake reduced, Occult blood positive

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/2
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 8/31/2010

VAERS ID: 284183 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B0876920 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abnormal faeces, Barium enema, Blood culture negative, Culture stool negative, Culture urine negative, Faeces discoloured, Intussusception, Lethargy, Mucosal dryness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Fluid intake reduced, Occult blood positive

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/2
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 5/13/2013

VAERS ID: 284183 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0876920 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abnormal faeces, Barium enema, Blood culture negative, Culture stool negative, Culture urine negative, Faeces discoloured, Intussusception, Lethargy, Mucosal dryness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Fluid intake reduced, Occult blood positive

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/2
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 2/14/2017

VAERS ID: 284183 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0876920 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abnormal faeces, Barium enema, Blood culture negative, Culture stool negative, Culture urine negative, Faeces discoloured, Intussusception, Lethargy, Mucosal dryness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Fluid intake reduced, Occult blood positive

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/2 5/23/2007 Multiple dilated bowel loops suggestive of distal bowel obstruction. Contrast enema with successful reduction. F/U Abd ultrasound with no evidence for recurrent intussusception. Stool, Blood and Urine cultures all (-).
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 9/14/2017

VAERS ID: 284183 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0876920 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/23/2007 Multiple dilated bowel loops suggestive of distal bowel obstruction. Contrast enema with successful reduction. F/U Abd ultrasound with no evidence for recurrent intussusception. Stool, Blood and Urine cultures all (-).
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 2/14/2018

VAERS ID: 284183 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0876920 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/23/2007 Multiple dilated bowel loops suggestive of distal bowel obstruction. Contrast enema with successful reduction. F/U Abd ultrasound with no evidence for recurrent intussusception. Stool, Blood and Urine cultures all (-).
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 6/14/2018

VAERS ID: 284183 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0876920 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/23/2007 Multiple dilated bowel loops suggestive of distal bowel obstruction. Contrast enema with successful reduction. F/U Abd ultrasound with no evidence for recurrent intussusception. Stool, Blood and Urine cultures all (-).
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 8/14/2018

VAERS ID: 284183 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0876920 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/23/2007 Multiple dilated bowel loops suggestive of distal bowel obstruction. Contrast enema with successful reduction. F/U Abd ultrasound with no evidence for recurrent intussusception. Stool, Blood and Urine cultures all (-).
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 9/14/2018

VAERS ID: 284183 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0876920 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/23/2007 Multiple dilated bowel loops suggestive of distal bowel obstruction. Contrast enema with successful reduction. F/U Abd ultrasound with no evidence for recurrent intussusception. Stool, Blood and Urine cultures all (-).
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

Changed on 10/14/2018

VAERS ID: 284183 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-15
Onset:2007-05-22
Submitted:2007-07-09
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628M / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1416F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0922 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0876920 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235N / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH:none.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: KUB showed distended small and large bowel loops. Barium enema done-intussusception identified and reduced. Repeat US was done post reduction with no evidence of recurrent IS. Labs and Diagnsotics: KUB 5/23/2007 Multiple dilated bowel loops suggestive of distal bowel obstruction. Contrast enema with successful reduction. F/U Abd ultrasound with no evidence for recurrent intussusception. Stool, Blood and Urine cultures all (-).
CDC 'Split Type': WAES0707USA00032

Write-up: Information has been received from a physician concerning a female who was vaccinated with Rotateq PO 2nd dose. Concomitant therapy included "other vaccines at the same time." Subsequently the patient developed an intussusception and was hospitalized. The physician reported that the intussusception was reduced with a barium enema and no surgery was needed. The physician reported that the patient recovered on an unspecified date. The physician reported that intussusception required intervention to prevent serious criteria and caused or prolonged hospitalization. Additional information has been requested. 07/18/2007 Vax record and Diagnostic studies from hospital stay received from PCP. Vax info updated in VAERS database. 07/30/2007 MR received for hospital DOS 5/22-24/2007. Infant presented to ER with 3 day hx of emesis, dark, foul smelling stools, decreased intake and lethargy. PE reveals lethargy, dry mucus membranes, a palpable mass in the RUQ, and guiac (+) stool. Final DX: Intussusception.

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