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Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Computerised tomogram abnormal, Haematochezia, Inappropriate schedule of drug administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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 11 month old male who on 27-FEB-2007 was vaccinated with Rotateq PO /"the last dose/". The patient developed an intussusception and was hospitalized. Subsequently, the patient recovered from int"ussusception. Intussusception was considered to be disabling, life threatening and caused hospitalization. Additional information has been requested.

Changed on 12/8/2009

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Barium double contrast, Computerised tomogram abnormal, Haematochezia, Inappropriate schedule of drug administration, Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown records received 10/5/07-CT showed intussusception. Small amount of air in proximal small bowel. Intussusception started in splenic flexure.
CDC 'Split Type': (blank) WAES0707USA01300

Write-up: Information has been received from a physician concerning an 11 month old male who on 27-FEB-2007 was vaccinated with Rotateq PO /"the "the last dose/". dose". The patient developed an intussusception and was hospitalized. Subsequently, the patient recovered from int"ussusception. intussusception. Intussusception was considered to be disabling, life threatening and caused hospitalization. Additional information has been requested. 10/5/07-records received from facility for DOS 5/23-5/25/07-Seen in ER. DX:Intussusception-reducted by fluoroscopically guided air enema. HX of abdominal pain and bloody stools this morning,

Changed on 5/13/2013

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Computerised tomogram abnormal, Haematochezia, Inappropriate schedule of drug administration, Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown records received 10/5/07-CT showed intussusception. Small amount of air in proximal small bowel. Intussusception started in splenic flexure.
CDC 'Split Type': WAES0707USA01300

Write-up: Information has been received from a physician concerning an 11 month old male who on 27-FEB-2007 was vaccinated with Rotateq PO "the last dose". The patient developed an intussusception and was hospitalized. Subsequently, the patient recovered from intussusception. Intussusception was considered to be disabling, life threatening and caused hospitalization. Additional information has been requested. 10/5/07-records received from facility for DOS 5/23-5/25/07-Seen in ER. DX:Intussusception-reducted by fluoroscopically guided air enema. HX of abdominal pain and bloody stools this morning,

Changed on 5/14/2017

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Computerised tomogram abnormal, Haematochezia, Inappropriate schedule of drug administration, Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown records received 10/5/07-CT showed intussusception. Small amount of air in proximal small bowel. Intussusception started in splenic flexure.
CDC 'Split Type': WAES0707USA01300

Write-up: Information has been received from a physician concerning an 11 month old male who on 27-FEB-2007 was vaccinated with Rotateq PO "the last dose". The patient developed an intussusception and was hospitalized. Subsequently, the patient recovered from intussusception. Intussusception was considered to be disabling, life threatening and caused hospitalization. Additional information has been requested. 10/5/07-records received from facility for DOS 5/23-5/25/07-Seen in ER. DX:Intussusception-reducted by fluoroscopically guided air enema. HX of abdominal pain and bloody stools this morning,

Changed on 9/14/2017

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown records received 10/5/07-CT showed intussusception. Small amount of air in proximal small bowel. Intussusception started in splenic flexure.
CDC 'Split Type': WAES0707USA01300

Write-up: Information has been received from a physician concerning an 11 month old male who on 27-FEB-2007 was vaccinated with Rotateq PO "the last dose". The patient developed an intussusception and was hospitalized. Subsequently, the patient recovered from intussusception. Intussusception was considered to be disabling, life threatening and caused hospitalization. Additional information has been requested. 10/5/07-records received from facility for DOS 5/23-5/25/07-Seen in ER. DX:Intussusception-reducted by fluoroscopically guided air enema. HX of abdominal pain and bloody stools this morning,

Changed on 2/14/2018

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown records received 10/5/07-CT showed intussusception. Small amount of air in proximal small bowel. Intussusception started in splenic flexure.
CDC 'Split Type': WAES0707USA01300

Write-up: Information has been received from a physician concerning an 11 month old male who on 27-FEB-2007 was vaccinated with Rotateq PO "the last dose". The patient developed an intussusception and was hospitalized. Subsequently, the patient recovered from intussusception. Intussusception was considered to be disabling, life threatening and caused hospitalization. Additional information has been requested. 10/5/07-records received from facility for DOS 5/23-5/25/07-Seen in ER. DX:Intussusception-reducted by fluoroscopically guided air enema. HX of abdominal pain and bloody stools this morning,

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