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This is VAERS ID 290658

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 290658
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Abdominal X-ray

Life Threatening? No
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: 7     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 concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-20"07 was sent to a children''''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available.


Changed on 12/8/2009

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': (blank) WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-20"07 05-SEP-2007 was sent to a children''''s children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 1/5/2010

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 3/2/2010

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 4/7/2010

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 8/31/2010

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (HEPTAVAX) HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 4/13/2011

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 5/13/2011

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 6/11/2011

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 1/7/2013

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a children''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 5/13/2013

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 6/14/2014

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 3/14/2015

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 2/14/2017

VAERS ID: 290658 Before After
VAERS Form:
Age:0.5 0.51
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 4/14/2017

VAERS ID: 290658 Before After
VAERS Form:
Age:0.51
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Intestinal ischaemia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray abnormal, Enema administration, Explorative laparotomy, Intestinal resection, Ultrasound scan normal, Abdominal X-ray

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 9/14/2017

VAERS ID: 290658 Before After
VAERS Form:(blank) 1
Age:0.51
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 3 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 2/14/2018

VAERS ID: 290658 Before After
VAERS Form:1
Age:0.51
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 3 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 6/14/2018

VAERS ID: 290658 Before After
VAERS Form:1
Age:0.51
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 3 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 8/14/2018

VAERS ID: 290658 Before After
VAERS Form:1
Age:0.51
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 3 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 9/14/2018

VAERS ID: 290658 Before After
VAERS Form:1
Age:0.51
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 3 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


Changed on 10/14/2018

VAERS ID: 290658 Before After
VAERS Form:1
Age:0.51
Gender:Female
Location:Pennsylvania
Vaccinated:2007-08-27
Onset:2007-09-04
Submitted:2007-09-14
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 3 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC 'Split Type': WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.

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