This is VAERS ID 292698

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID:	292698
VAERS Form:
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 0	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B26510E / 0	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0	- / PO

Administered by: Other Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Enema administration, 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? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Changed on 12/8/2009

VAERS ID:	292698 Before After
VAERS Form:
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0	- / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 0	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B26510E / 0	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0	- / PO

Administered by: Other Purchased by: Unknown Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Enema administration, Abdominal X-ray, Oral intake reduced

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''''s physician''s office. The patient''''s patient''s outcome was unknown at the t"ime time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 3/2/2010

VAERS ID:	292698 Before After
VAERS Form:
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 0	- / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC	B26510E / 0	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0	- / PO

Administered by: Other Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Enema administration, Abdominal X-ray, Oral intake reduced

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 4/7/2010

VAERS ID:	292698 Before After
VAERS Form:
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 0	- / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B26510E / 0	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0	- / PO

Administered by: Other Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Enema administration, Abdominal X-ray, Oral intake reduced

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 8/31/2010

VAERS ID:	292698 Before After
VAERS Form:
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 0	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH	B26510E / 0	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0	- / PO

Administered by: Other Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Enema administration, Abdominal X-ray, Oral intake reduced

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 5/13/2013

VAERS ID:	292698 Before After
VAERS Form:
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 0	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 0	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0	- / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0	- / PO

Administered by: Other Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Enema administration, Abdominal X-ray, Oral intake reduced

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 4/14/2017

VAERS ID:	292698 Before After
VAERS Form:
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 0	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 0	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0	- / PO

Administered by: Other Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Enema administration, Abdominal X-ray, Oral intake reduced

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 9/14/2017

VAERS ID:	292698 Before After
VAERS Form:	(blank) 1
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 0 1	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 0 1	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 0 1	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 0 1	- MO / PO

Administered by: Other Purchased by: Other
Symptoms: Intussusception

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 2/14/2018

VAERS ID:	292698 Before After
VAERS Form:	1
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 1	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 1	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 1	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 1	MO / PO

Administered by: Other Purchased by: Other
Symptoms: Intussusception

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 6/14/2018

VAERS ID:	292698 Before After
VAERS Form:	1
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 1	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 1	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 1	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 1	MO / PO

Administered by: Other Purchased by: Other
Symptoms: Intussusception

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 8/14/2018

VAERS ID:	292698 Before After
VAERS Form:	1
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 1	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 1	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 1	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 1	MO / PO

Administered by: Other Purchased by: Other
Symptoms: Intussusception

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 9/14/2018

VAERS ID:	292698 Before After
VAERS Form:	1
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 1	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 1	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 1	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 1	MO / PO

Administered by: Other Purchased by: Other
Symptoms: Intussusception

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

Changed on 10/14/2018

VAERS ID:	292698 Before After
VAERS Form:	1
Age:	0.2
Gender:	Female
Location:	North Dakota

Vaccinated:	2007-08-02
Onset:	2007-09-13
Submitted:	2007-10-10
Entered:	2007-10-11

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B133BA / 1	- / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0066U / 1	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 1	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0507U / 1	MO / PO

Administered by: Other Purchased by: Other
Symptoms: Intussusception

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.

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