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This is VAERS ID 297890

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 297890
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0273 / 0 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Enema administration, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
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 physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and mel"ioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complain


Changed on 12/8/2009

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0273 / 0 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': (blank) WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and mel"ioration. melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complain complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 7/31/2010

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0273 / 0 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 8/31/2010

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0273 / 0 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 1/4/2011

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0273 / 0 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 4/13/2011

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0273 / 0 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 5/13/2011

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0273 / 0 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 6/11/2011

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0273 / 0 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 7/13/2012

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) DTAP (DAPTACEL) / UNKNOWN MANUFACTURER SANOFI PASTEUR C2765AA / 1 - / -
HEP: HEP B (NO BRAND NAME) HEP B (RECOMBIVAX HB) / UNKNOWN MANUFACTURER MERCK & CO. INC. 0007U / 1 - / -
HIBV: HIB (NO BRAND NAME) HIB (ACTHIB) / UNKNOWN MANUFACTURER SANOFI PASTEUR UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) POLIO VIRUS, INACT. (POLIOVAX) / UNKNOWN MANUFACTURER SANOFI PASTEUR A0273 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 5/13/2013

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 6/14/2014

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 2/14/2017

VAERS ID: 297890 Before After
VAERS Form:
Age:0.4 0.39
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 4/14/2017

VAERS ID: 297890 Before After
VAERS Form:
Age:0.39
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 1 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Diet refusal, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Lethargy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal malrotation

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 9/14/2017

VAERS ID: 297890 Before After
VAERS Form:(blank) 1
Age:0.39
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 1 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 1 2 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 0 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 2/14/2018

VAERS ID: 297890 Before After
VAERS Form:1
Age:0.39
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 2 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 6/14/2018

VAERS ID: 297890 Before After
VAERS Form:1
Age:0.39
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 2 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


Changed on 8/14/2018

VAERS ID: 297890 Before After
VAERS Form:1
Age:0.39
Gender:Female
Location:South Carolina
Vaccinated:2007-09-21
Onset:2007-10-29
Submitted:2007-11-26
Entered:2007-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 2 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery

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? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC 'Split Type': WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.

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