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This is VAERS ID 285684

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 285684
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intus"susception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additio


Changed on 12/8/2009

VAERS ID: 285684 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Neutrophil count increased, Surgery, Vomiting, Protein urine present, Abdominal X-ray, Rotavirus test negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal ser
CDC 'Split Type': (blank) WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intus"susception intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additio Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 1/5/2010

VAERS ID: 285684 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Neutrophil count increased, Surgery, Vomiting, Protein urine present, Abdominal X-ray, Rotavirus test negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal ser
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 1/4/2011

VAERS ID: 285684 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal ser series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 4/13/2011

VAERS ID: 285684 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Neutrophil count increased, Surgery, Vomiting, Protein urine present, Abdominal X-ray, Rotavirus test negative

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 5/13/2011

VAERS ID: 285684 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Neutrophil count increased, Surgery, Vomiting, Protein urine present, Abdominal X-ray, Rotavirus test negative

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 6/11/2011

VAERS ID: 285684 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Neutrophil count increased, Surgery, Vomiting, Protein urine present, Abdominal X-ray, Rotavirus test negative

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 5/13/2013

VAERS ID: 285684 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Neutrophil count increased, Surgery, Vomiting, Protein urine present, Abdominal X-ray, Rotavirus test negative

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 5/14/2017

VAERS ID: 285684 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Neutrophil count increased, Surgery, Vomiting, Protein urine present, Abdominal X-ray, Rotavirus test negative

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 9/14/2017

VAERS ID: 285684 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 2 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 3 - 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 2/14/2018

VAERS ID: 285684 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 2 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 3 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 6/14/2018

VAERS ID: 285684 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 2 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 3 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 8/14/2018

VAERS ID: 285684 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 2 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 3 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


Changed on 9/14/2018

VAERS ID: 285684 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-06-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 2 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 3 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC 'Split Type': WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,

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