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This is VAERS ID 300448

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 300448
VAERS Form:
Age:0.3
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody st"ool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd

Changed on 12/8/2009

VAERS ID: 300448 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody st"ool, stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 1/5/2010

VAERS ID: 300448 Before After
VAERS Form:
Age:0.3 0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 3/2/2010

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 4/7/2010

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 8/31/2010

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 4/13/2011

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 5/13/2011

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 6/11/2011

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 5/13/2013

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 6/14/2014

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 2/14/2017

VAERS ID: 300448 Before After
VAERS Form:
Age:0.4 0.35
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 9/14/2017

VAERS ID: 300448 Before After
VAERS Form:(blank) 1
Age:0.35
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 1 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 2/14/2018

VAERS ID: 300448 Before After
VAERS Form:1
Age:0.35
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 6/14/2018

VAERS ID: 300448 Before After
VAERS Form:1
Age:0.35
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

Changed on 8/14/2018

VAERS ID: 300448 Before After
VAERS Form:1
Age:0.35
Gender:Female
Location:Maine
Vaccinated:2007-10-18
Onset:2007-11-15
Submitted:2007-12-13
Entered:2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2489AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 202402 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC 'Split Type':

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

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