This is VAERS ID 295492

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 1	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B26510E / 1	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1	- / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool negative, Diarrhoea, Gastroenteritis viral, Enema administration, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery"was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in V

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Changed on 12/8/2009

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 1	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B26510E / 1	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1	- / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool negative, Diarrhoea, Gastroenteritis viral, Inguinal hernia, Intussusception, Large intestine perforation, Mucous stools, Pyrexia, Surgery, Vomiting, Pneumoperitoneum, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased, Rotavirus test negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': (blank) WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery"was Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in V VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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Changed on 3/2/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 1	- / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC	B26510E / 1	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1	- / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool negative, Diarrhoea, Gastroenteritis viral, Inguinal hernia, Intussusception, Large intestine perforation, Mucous stools, Pyrexia, Surgery, Vomiting, Pneumoperitoneum, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased, Rotavirus test negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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Changed on 4/7/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 1	- / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B26510E / 1	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1	- / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool negative, Diarrhoea, Gastroenteritis viral, Inguinal hernia, Intussusception, Large intestine perforation, Mucous stools, Pyrexia, Surgery, Vomiting, Pneumoperitoneum, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased, Rotavirus test negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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Changed on 8/31/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 1	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH	B26510E / 1	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1	- / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool negative, Diarrhoea, Gastroenteritis viral, Inguinal hernia, Intussusception, Large intestine perforation, Mucous stools, Pyrexia, Surgery, Vomiting, Pneumoperitoneum, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased, Rotavirus test negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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Changed on 5/13/2013

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 1	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 1	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1	- / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1	- / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool negative, Diarrhoea, Gastroenteritis viral, Inguinal hernia, Intussusception, Large intestine perforation, Mucous stools, Pyrexia, Surgery, Vomiting, Pneumoperitoneum, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased, Rotavirus test negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

---

Changed on 2/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 1	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 1	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1	- / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool negative, Diarrhoea, Gastroenteritis viral, Inguinal hernia, Intussusception, Large intestine perforation, Mucous stools, Pyrexia, Surgery, Vomiting, Pneumoperitoneum, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased, Rotavirus test negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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Changed on 9/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 1 2	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 1 2	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 1 2	- MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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Changed on 2/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 2	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 2	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 2	MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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Changed on 6/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 2	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 2	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 2	MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

---

Changed on 8/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 2	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 2	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 2	MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

---

Changed on 9/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 2	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 2	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 2	MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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Changed on 10/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0078U / 2	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B26510E / 2	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1116F / 2	MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC 'Split Type': WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.

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