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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 292698 |
VAERS Form: | |
Age: | 0.2 |
Sex: | 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':
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 t"ime 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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': (blank) WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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.
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
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 LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC 'Split Type': WAES0710USA00520
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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