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This is VAERS ID 285151

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 285151
VAERS Form:
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670D / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Appendicectomy, Intussusception, Lethargy, Surgery, Enema administration

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: 6     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''''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No addit"ional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested.


Changed on 12/8/2009

VAERS ID: 285151 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670D / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Appendicectomy, Intussusception, Lethargy, Surgery, Vomiting, Enema administration

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': (blank) WAES0707USA01897

Write-up: Information has been received from a physician''''s physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No addit"ional additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 3/2/2010

VAERS ID: 285151 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08670D / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Lethargy, Surgery, Vomiting, Enema administration

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 4/7/2010

VAERS ID: 285151 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670D / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Lethargy, Surgery, Vomiting, Enema administration

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 8/31/2010

VAERS ID: 285151 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08670D / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Lethargy, Surgery, Vomiting, Enema administration

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 5/13/2013

VAERS ID: 285151 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Lethargy, Surgery, Vomiting, Enema administration

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 5/14/2017

VAERS ID: 285151 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Intussusception, Lethargy, Surgery, Vomiting, Enema administration

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 9/14/2017

VAERS ID: 285151 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 2 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 1 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 2/14/2018

VAERS ID: 285151 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 2 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 6/14/2018

VAERS ID: 285151 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 2 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


Changed on 8/14/2018

VAERS ID: 285151 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Unknown
Vaccinated:2007-03-20
Onset:2007-05-21
Submitted:2007-07-18
Entered:2007-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 2 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC 'Split Type': WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus

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