This is VAERS ID 297390

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1	RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B08697C / 1	LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1	- / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea haemorrhagic, Intussusception, Laparotomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physi"cian''''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was report

---

Changed on 12/8/2009

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1	RL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1	RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B08697C / 1	LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1	- / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Barium enema, Diarrhoea haemorrhagic, Intussusception, Laparotomy, Vomiting, X-ray, Ultrasound abdomen abnormal, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': (blank) WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physi"cian''''s physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was report reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 3/2/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1	RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC	B08697C / 1	LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1	- / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Diarrhoea haemorrhagic, Intussusception, Laparotomy, Vomiting, X-ray, Ultrasound abdomen abnormal, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 4/7/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1	RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B08697C / 1	LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1	- / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Diarrhoea haemorrhagic, Intussusception, Laparotomy, Vomiting, X-ray, Ultrasound abdomen abnormal, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 8/31/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1	RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH	B08697C / 1	LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1	- / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Diarrhoea haemorrhagic, Intussusception, Laparotomy, Vomiting, X-ray, Ultrasound abdomen abnormal, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 5/13/2013

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 1	LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1	- / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1	- / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Diarrhoea haemorrhagic, Intussusception, Laparotomy, Vomiting, X-ray, Ultrasound abdomen abnormal, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 4/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 1	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1	- / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Diarrhoea haemorrhagic, Intussusception, Laparotomy, Vomiting, X-ray, Ultrasound abdomen abnormal, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 9/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 1 2	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 1 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 1 2	- MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 2/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 2	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 2	MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 6/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 2	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 2	MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 8/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 2	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 2	MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 9/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 2	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 2	MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 10/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 2	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 2	MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

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Changed on 12/24/2020

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 2	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 2	MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

---

Changed on 12/30/2020

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B0976B / 2	RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08697C / 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	02424 / 2	MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC 'Split Type': WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.

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