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This is VAERS ID 288911

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288911
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692H / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Aspartate aminotransferase increased, Basophil count decreased, Computerised tomogram abnormal, Gastrointestinal tube insertion, Abdominal X-ray

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: 5     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 nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed i"ntussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling a


Changed on 12/8/2009

VAERS ID: 288911 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692H / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Aspartate aminotransferase increased, Basophil count decreased, Computerised tomogram abnormal, Intussusception, Lethargy, Lymphocyte count decreased, Neutrophil count increased, Small intestinal obstruction, Surgery, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen normal, Gastrointestinal tube insertion, Intestinal resection, Intestinal anastomosis, Postoperative adhesion, Abdominal X-ray

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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: intussusception, 6/07, surgically reduced, w/half of large intestine & small amount of small intestine & appendix removed. Tonsillectomy 5 wks prior to current admit.
Allergies:
Diagnostic Lab Data: Unknown 6/20 Admit LABS: abdominal x-rays c/w acute SBO. 8/1 Admit LABS: CT of abdomen revealed SBO. Abdominal x-ray WNL. US of abdomen WNL. WBC 23.5 (H), platelets 680 (H), lymphs 42 (L), neutros 58 (H), baso 0 (L) on admit. AST on a
CDC 'Split Type': (blank) WAES0708USA02905

Write-up: Information has been received from a nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed i"ntussusception. intussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling and an other important medical event (surgery) by the reporter. Additional information has been requested. 8/31/07 Received patient demographics from CDC. 9/4/07 Received vax record from pcp. VAERS database updated w/same. 10/5/07 Reviewed hospital medical records which reveal patient experienced copious bilious drainage from NGT & dx w/ SBO. Had previous surgery of ileocolic resection w/primary anastomosis for IS w/dead bowel. Admitted 8/1-8/7/2007. Operative findings on 8/3 was a very tough cord like adhesion going straight across the ileum about 4-5 cm prior to earlier anastamosis w/colon. Adhesion was lysed & small bowel was functional & healthy. Multiple other smaller adhesions were lysed as well. Admitted to PICU for post op observation. FINAL DX: No D/C summary included. Recurrent intussusception, surgically reduced. 10/5/07 Received D/C summary. Patient had bilious vomiting. Laparotomy & lysis of adhesions as above. FINAL DX: postoperative bowel obstruction, surgically reduced. Records faxed to CDC. 10/29/07 Reviewed hospital medical records which reveal patient experienced bilious vomiting & lethargy x 1 day. Admitted 6/20-6/25/2007. Taken to OR for probable mid-gut volvulus & found to have incarcerated ileocolic IS w/necrotic ileum. Right colon resection w/primary anastomosis was done. Progressed well & d/c to home FINAL DX: Ileocolic intussusception, surgically reduced. Records faxed to CDC.


Changed on 3/2/2010

VAERS ID: 288911 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 0 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08692H / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Aspartate aminotransferase increased, Basophil count decreased, Computerised tomogram abnormal, Intussusception, Lethargy, Lymphocyte count decreased, Neutrophil count increased, Small intestinal obstruction, Surgery, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen normal, Gastrointestinal tube insertion, Intestinal resection, Intestinal anastomosis, Postoperative adhesion, Abdominal X-ray

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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: intussusception, 6/07, surgically reduced, w/half of large intestine & small amount of small intestine & appendix removed. Tonsillectomy 5 wks prior to current admit.
Allergies:
Diagnostic Lab Data: Unknown 6/20 Admit LABS: abdominal x-rays c/w acute SBO. 8/1 Admit LABS: CT of abdomen revealed SBO. Abdominal x-ray WNL. US of abdomen WNL. WBC 23.5 (H), platelets 680 (H), lymphs 42 (L), neutros 58 (H), baso 0 (L) on admit. AST on a
CDC 'Split Type': WAES0708USA02905

Write-up: Information has been received from a nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed intussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling and an other important medical event (surgery) by the reporter. Additional information has been requested. 8/31/07 Received patient demographics from CDC. 9/4/07 Received vax record from pcp. VAERS database updated w/same. 10/5/07 Reviewed hospital medical records which reveal patient experienced copious bilious drainage from NGT & dx w/ SBO. Had previous surgery of ileocolic resection w/primary anastomosis for IS w/dead bowel. Admitted 8/1-8/7/2007. Operative findings on 8/3 was a very tough cord like adhesion going straight across the ileum about 4-5 cm prior to earlier anastamosis w/colon. Adhesion was lysed & small bowel was functional & healthy. Multiple other smaller adhesions were lysed as well. Admitted to PICU for post op observation. FINAL DX: No D/C summary included. Recurrent intussusception, surgically reduced. 10/5/07 Received D/C summary. Patient had bilious vomiting. Laparotomy & lysis of adhesions as above. FINAL DX: postoperative bowel obstruction, surgically reduced. Records faxed to CDC. 10/29/07 Reviewed hospital medical records which reveal patient experienced bilious vomiting & lethargy x 1 day. Admitted 6/20-6/25/2007. Taken to OR for probable mid-gut volvulus & found to have incarcerated ileocolic IS w/necrotic ileum. Right colon resection w/primary anastomosis was done. Progressed well & d/c to home FINAL DX: Ileocolic intussusception, surgically reduced. Records faxed to CDC.


Changed on 4/7/2010

VAERS ID: 288911 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 0 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692H / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Aspartate aminotransferase increased, Basophil count decreased, Computerised tomogram abnormal, Intussusception, Lethargy, Lymphocyte count decreased, Neutrophil count increased, Small intestinal obstruction, Surgery, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen normal, Gastrointestinal tube insertion, Intestinal resection, Intestinal anastomosis, Postoperative adhesion, Abdominal X-ray

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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: intussusception, 6/07, surgically reduced, w/half of large intestine & small amount of small intestine & appendix removed. Tonsillectomy 5 wks prior to current admit.
Allergies:
Diagnostic Lab Data: Unknown 6/20 Admit LABS: abdominal x-rays c/w acute SBO. 8/1 Admit LABS: CT of abdomen revealed SBO. Abdominal x-ray WNL. US of abdomen WNL. WBC 23.5 (H), platelets 680 (H), lymphs 42 (L), neutros 58 (H), baso 0 (L) on admit. AST on a
CDC 'Split Type': WAES0708USA02905

Write-up: Information has been received from a nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed intussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling and an other important medical event (surgery) by the reporter. Additional information has been requested. 8/31/07 Received patient demographics from CDC. 9/4/07 Received vax record from pcp. VAERS database updated w/same. 10/5/07 Reviewed hospital medical records which reveal patient experienced copious bilious drainage from NGT & dx w/ SBO. Had previous surgery of ileocolic resection w/primary anastomosis for IS w/dead bowel. Admitted 8/1-8/7/2007. Operative findings on 8/3 was a very tough cord like adhesion going straight across the ileum about 4-5 cm prior to earlier anastamosis w/colon. Adhesion was lysed & small bowel was functional & healthy. Multiple other smaller adhesions were lysed as well. Admitted to PICU for post op observation. FINAL DX: No D/C summary included. Recurrent intussusception, surgically reduced. 10/5/07 Received D/C summary. Patient had bilious vomiting. Laparotomy & lysis of adhesions as above. FINAL DX: postoperative bowel obstruction, surgically reduced. Records faxed to CDC. 10/29/07 Reviewed hospital medical records which reveal patient experienced bilious vomiting & lethargy x 1 day. Admitted 6/20-6/25/2007. Taken to OR for probable mid-gut volvulus & found to have incarcerated ileocolic IS w/necrotic ileum. Right colon resection w/primary anastomosis was done. Progressed well & d/c to home FINAL DX: Ileocolic intussusception, surgically reduced. Records faxed to CDC.


Changed on 8/31/2010

VAERS ID: 288911 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08692H / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Aspartate aminotransferase increased, Basophil count decreased, Computerised tomogram abnormal, Intussusception, Lethargy, Lymphocyte count decreased, Neutrophil count increased, Small intestinal obstruction, Surgery, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen normal, Gastrointestinal tube insertion, Intestinal resection, Intestinal anastomosis, Postoperative adhesion, Abdominal X-ray

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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: intussusception, 6/07, surgically reduced, w/half of large intestine & small amount of small intestine & appendix removed. Tonsillectomy 5 wks prior to current admit.
Allergies:
Diagnostic Lab Data: Unknown 6/20 Admit LABS: abdominal x-rays c/w acute SBO. 8/1 Admit LABS: CT of abdomen revealed SBO. Abdominal x-ray WNL. US of abdomen WNL. WBC 23.5 (H), platelets 680 (H), lymphs 42 (L), neutros 58 (H), baso 0 (L) on admit. AST on a
CDC 'Split Type': WAES0708USA02905

Write-up: Information has been received from a nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed intussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling and an other important medical event (surgery) by the reporter. Additional information has been requested. 8/31/07 Received patient demographics from CDC. 9/4/07 Received vax record from pcp. VAERS database updated w/same. 10/5/07 Reviewed hospital medical records which reveal patient experienced copious bilious drainage from NGT & dx w/ SBO. Had previous surgery of ileocolic resection w/primary anastomosis for IS w/dead bowel. Admitted 8/1-8/7/2007. Operative findings on 8/3 was a very tough cord like adhesion going straight across the ileum about 4-5 cm prior to earlier anastamosis w/colon. Adhesion was lysed & small bowel was functional & healthy. Multiple other smaller adhesions were lysed as well. Admitted to PICU for post op observation. FINAL DX: No D/C summary included. Recurrent intussusception, surgically reduced. 10/5/07 Received D/C summary. Patient had bilious vomiting. Laparotomy & lysis of adhesions as above. FINAL DX: postoperative bowel obstruction, surgically reduced. Records faxed to CDC. 10/29/07 Reviewed hospital medical records which reveal patient experienced bilious vomiting & lethargy x 1 day. Admitted 6/20-6/25/2007. Taken to OR for probable mid-gut volvulus & found to have incarcerated ileocolic IS w/necrotic ileum. Right colon resection w/primary anastomosis was done. Progressed well & d/c to home FINAL DX: Ileocolic intussusception, surgically reduced. Records faxed to CDC.


Changed on 5/13/2013

VAERS ID: 288911 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Aspartate aminotransferase increased, Basophil count decreased, Computerised tomogram abnormal, Intussusception, Lethargy, Lymphocyte count decreased, Neutrophil count increased, Small intestinal obstruction, Surgery, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen normal, Gastrointestinal tube insertion, Intestinal resection, Intestinal anastomosis, Postoperative adhesion, Abdominal X-ray

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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: intussusception, 6/07, surgically reduced, w/half of large intestine & small amount of small intestine & appendix removed. Tonsillectomy 5 wks prior to current admit.
Allergies:
Diagnostic Lab Data: Unknown 6/20 Admit LABS: abdominal x-rays c/w acute SBO. 8/1 Admit LABS: CT of abdomen revealed SBO. Abdominal x-ray WNL. US of abdomen WNL. WBC 23.5 (H), platelets 680 (H), lymphs 42 (L), neutros 58 (H), baso 0 (L) on admit. AST on a
CDC 'Split Type': WAES0708USA02905

Write-up: Information has been received from a nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed intussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling and an other important medical event (surgery) by the reporter. Additional information has been requested. 8/31/07 Received patient demographics from CDC. 9/4/07 Received vax record from pcp. VAERS database updated w/same. 10/5/07 Reviewed hospital medical records which reveal patient experienced copious bilious drainage from NGT & dx w/ SBO. Had previous surgery of ileocolic resection w/primary anastomosis for IS w/dead bowel. Admitted 8/1-8/7/2007. Operative findings on 8/3 was a very tough cord like adhesion going straight across the ileum about 4-5 cm prior to earlier anastamosis w/colon. Adhesion was lysed & small bowel was functional & healthy. Multiple other smaller adhesions were lysed as well. Admitted to PICU for post op observation. FINAL DX: No D/C summary included. Recurrent intussusception, surgically reduced. 10/5/07 Received D/C summary. Patient had bilious vomiting. Laparotomy & lysis of adhesions as above. FINAL DX: postoperative bowel obstruction, surgically reduced. Records faxed to CDC. 10/29/07 Reviewed hospital medical records which reveal patient experienced bilious vomiting & lethargy x 1 day. Admitted 6/20-6/25/2007. Taken to OR for probable mid-gut volvulus & found to have incarcerated ileocolic IS w/necrotic ileum. Right colon resection w/primary anastomosis was done. Progressed well & d/c to home FINAL DX: Ileocolic intussusception, surgically reduced. Records faxed to CDC.


Changed on 2/14/2017

VAERS ID: 288911 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 0 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Aspartate aminotransferase increased, Basophil count decreased, Computerised tomogram abnormal, Intussusception, Lethargy, Lymphocyte count decreased, Neutrophil count increased, Small intestinal obstruction, Surgery, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen normal, Gastrointestinal tube insertion, Intestinal resection, Intestinal anastomosis, Postoperative adhesion, Abdominal X-ray

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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: intussusception, 6/07, surgically reduced, w/half of large intestine & small amount of small intestine & appendix removed. Tonsillectomy 5 wks prior to current admit.
Allergies:
Diagnostic Lab Data: Unknown 6/20 Admit LABS: abdominal x-rays c/w acute SBO. 8/1 Admit LABS: CT of abdomen revealed SBO. Abdominal x-ray WNL. US of abdomen WNL. WBC 23.5 (H), platelets 680 (H), lymphs 42 (L), neutros 58 (H), baso 0 (L) on admit. AST on a admit 44 (H)
CDC 'Split Type': WAES0708USA02905

Write-up: Information has been received from a nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed intussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling and an other important medical event (surgery) by the reporter. Additional information has been requested. 8/31/07 Received patient demographics from CDC. 9/4/07 Received vax record from pcp. VAERS database updated w/same. 10/5/07 Reviewed hospital medical records which reveal patient experienced copious bilious drainage from NGT & dx w/ SBO. Had previous surgery of ileocolic resection w/primary anastomosis for IS w/dead bowel. Admitted 8/1-8/7/2007. Operative findings on 8/3 was a very tough cord like adhesion going straight across the ileum about 4-5 cm prior to earlier anastamosis w/colon. Adhesion was lysed & small bowel was functional & healthy. Multiple other smaller adhesions were lysed as well. Admitted to PICU for post op observation. FINAL DX: No D/C summary included. Recurrent intussusception, surgically reduced. 10/5/07 Received D/C summary. Patient had bilious vomiting. Laparotomy & lysis of adhesions as above. FINAL DX: postoperative bowel obstruction, surgically reduced. Records faxed to CDC. 10/29/07 Reviewed hospital medical records which reveal patient experienced bilious vomiting & lethargy x 1 day. Admitted 6/20-6/25/2007. Taken to OR for probable mid-gut volvulus & found to have incarcerated ileocolic IS w/necrotic ileum. Right colon resection w/primary anastomosis was done. Progressed well & d/c to home FINAL DX: Ileocolic intussusception, surgically reduced. Records faxed to CDC.


Changed on 9/14/2017

VAERS ID: 288911 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 1 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 0 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 0 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 0 1 - MO / PO

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

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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: intussusception, 6/07, surgically reduced, w/half of large intestine & small amount of small intestine & appendix removed. Tonsillectomy 5 wks prior to current admit.
Allergies:
Diagnostic Lab Data: Unknown 6/20 Admit LABS: abdominal x-rays c/w acute SBO. 8/1 Admit LABS: CT of abdomen revealed SBO. Abdominal x-ray WNL. US of abdomen WNL. WBC 23.5 (H), platelets 680 (H), lymphs 42 (L), neutros 58 (H), baso 0 (L) on admit. AST on admit 44 (H)
CDC 'Split Type': WAES0708USA02905

Write-up: Information has been received from a nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed intussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling and an other important medical event (surgery) by the reporter. Additional information has been requested. 8/31/07 Received patient demographics from CDC. 9/4/07 Received vax record from pcp. VAERS database updated w/same. 10/5/07 Reviewed hospital medical records which reveal patient experienced copious bilious drainage from NGT & dx w/ SBO. Had previous surgery of ileocolic resection w/primary anastomosis for IS w/dead bowel. Admitted 8/1-8/7/2007. Operative findings on 8/3 was a very tough cord like adhesion going straight across the ileum about 4-5 cm prior to earlier anastamosis w/colon. Adhesion was lysed & small bowel was functional & healthy. Multiple other smaller adhesions were lysed as well. Admitted to PICU for post op observation. FINAL DX: No D/C summary included. Recurrent intussusception, surgically reduced. 10/5/07 Received D/C summary. Patient had bilious vomiting. Laparotomy & lysis of adhesions as above. FINAL DX: postoperative bowel obstruction, surgically reduced. Records faxed to CDC. 10/29/07 Reviewed hospital medical records which reveal patient experienced bilious vomiting & lethargy x 1 day. Admitted 6/20-6/25/2007. Taken to OR for probable mid-gut volvulus & found to have incarcerated ileocolic IS w/necrotic ileum. Right colon resection w/primary anastomosis was done. Progressed well & d/c to home FINAL DX: Ileocolic intussusception, surgically reduced. Records faxed to CDC.


Changed on 2/14/2018

VAERS ID: 288911 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Unknown
Vaccinated:2007-05-29
Onset:2007-06-20
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1417F / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0031U / 1 MO / PO

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

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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: intussusception, 6/07, surgically reduced, w/half of large intestine & small amount of small intestine & appendix removed. Tonsillectomy 5 wks prior to current admit.
Allergies:
Diagnostic Lab Data: Unknown 6/20 Admit LABS: abdominal x-rays c/w acute SBO. 8/1 Admit LABS: CT of abdomen revealed SBO. Abdominal x-ray WNL. US of abdomen WNL. WBC 23.5 (H), platelets 680 (H), lymphs 42 (L), neutros 58 (H), baso 0 (L) on admit. AST on admit 44 (H)
CDC 'Split Type': WAES0708USA02905

Write-up: Information has been received from a nurse practitioner concerning a 3 month old male who was vaccinated with a 2ml oral dose of Rotateq (No lot number was provided). The nurse practitioner reported within 3 weeks after vaccination the patient developed intussusception. Medical attention was sought and the patient was hospitalized and underwent surgery. Subsequently, the patient recovered. There was no product quality complaint. The event was also considered to be immediately life-threatening, disabling and an other important medical event (surgery) by the reporter. Additional information has been requested. 8/31/07 Received patient demographics from CDC. 9/4/07 Received vax record from pcp. VAERS database updated w/same. 10/5/07 Reviewed hospital medical records which reveal patient experienced copious bilious drainage from NGT & dx w/ SBO. Had previous surgery of ileocolic resection w/primary anastomosis for IS w/dead bowel. Admitted 8/1-8/7/2007. Operative findings on 8/3 was a very tough cord like adhesion going straight across the ileum about 4-5 cm prior to earlier anastamosis w/colon. Adhesion was lysed & small bowel was functional & healthy. Multiple other smaller adhesions were lysed as well. Admitted to PICU for post op observation. FINAL DX: No D/C summary included. Recurrent intussusception, surgically reduced. 10/5/07 Received D/C summary. Patient had bilious vomiting. Laparotomy & lysis of adhesions as above. FINAL DX: postoperative bowel obstruction, surgically reduced. Records faxed to CDC. 10/29/07 Reviewed hospital medical records which reveal patient experienced bilious vomiting & lethargy x 1 day. Admitted 6/20-6/25/2007. Taken to OR for probable mid-gut volvulus & found to have incarcerated ileocolic IS w/necrotic ileum. Right colon resection w/primary anastomosis was done. Progressed well & d/c to home FINAL DX: Ileocolic intussusception, surgically reduced. Records faxed to CDC.


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