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This is VAERS ID 299161

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 299161
VAERS Form:
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Enema administration, Explorative laparotomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR receive"d for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt on


Changed on 12/8/2009

VAERS ID: 299161 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR receive"d received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 3/2/2010

VAERS ID: 299161 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 1 LL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08700K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 4/7/2010

VAERS ID: 299161 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 1 LL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 8/31/2010

VAERS ID: 299161 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08700K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 5/13/2013

VAERS ID: 299161 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 4/14/2017

VAERS ID: 299161 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 9/14/2017

VAERS ID: 299161 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 1 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery, Enema administration, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 2/14/2018

VAERS ID: 299161 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery, Enema administration, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 6/14/2018

VAERS ID: 299161 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery, Enema administration, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 8/14/2018

VAERS ID: 299161 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery, Enema administration, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 9/14/2018

VAERS ID: 299161 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery, Enema administration, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


Changed on 10/14/2018

VAERS ID: 299161 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Ohio
Vaccinated:2007-10-25
Onset:2007-11-24
Submitted:2007-12-03
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery, Enema administration, Intestinal resection

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC 'Split Type':

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.

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