![]() |
National Vaccine Information Center Your Health. Your Family. Your Choice. |
MedAlerts Home |
History of Changes from the VAERS Wayback Machine |
VAERS ID: | 294451 |
VAERS Form: | |
Age: | 0.3 |
Sex: | Male |
Location: | Virginia |
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B54007F / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Enema administration, Abdominal X-ray
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B54007F / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - | - / PO |
Administered by: Private Purchased by: Unknown Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, Abdominal X-ray
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B54007F / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, Abdominal X-ray
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 1 | RL / IM |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B54007F / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, Abdominal X-ray
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B54007F / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, Abdominal X-ray
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, Abdominal X-ray
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, Abdominal X-ray
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 1 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 1 2 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 1 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / - UNK | - MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 2 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / UNK | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 2 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / UNK | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 2 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / UNK | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 2 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / UNK | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 2 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / UNK | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 2 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / UNK | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Vaccinated: | 2007-09-12 |
Onset: | 2007-10-21 |
Submitted: | 2007-10-22 |
Entered: | 2007-10-25 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2651AA / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF116AC / 2 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | Z0873 / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1052U / UNK | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=294451&WAYBACKHISTORY=ON
Copyright ©
2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166