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This is VAERS ID 299144

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 299144
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08684K / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Haematochezia, Intussusception, Lethargy

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of ro"tavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the fi


Changed on 12/8/2009

VAERS ID: 299144 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08684K / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Barium enema abnormal, Haematochezia, Intussusception, Lethargy, Tachycardia, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': (blank) WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of ro"tavirus rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the fi first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 3/2/2010

VAERS ID: 299144 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08684K / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema abnormal, Haematochezia, Intussusception, Lethargy, Tachycardia, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 4/7/2010

VAERS ID: 299144 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08684K / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema abnormal, Haematochezia, Intussusception, Lethargy, Tachycardia, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 8/31/2010

VAERS ID: 299144 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08684K / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema abnormal, Haematochezia, Intussusception, Lethargy, Tachycardia, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 5/13/2013

VAERS ID: 299144 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684K / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema abnormal, Haematochezia, Intussusception, Lethargy, Tachycardia, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 4/14/2017

VAERS ID: 299144 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684K / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema abnormal, Haematochezia, Intussusception, Lethargy, Tachycardia, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 9/14/2017

VAERS ID: 299144 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 1 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684K / 1 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 2/14/2018

VAERS ID: 299144 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684K / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 6/14/2018

VAERS ID: 299144 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684K / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


Changed on 8/14/2018

VAERS ID: 299144 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:South Carolina
Vaccinated:2007-03-30
Onset:2007-04-11
Submitted:2007-12-07
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684K / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC 'Split Type': WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.

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