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VAERS ID: | 300448 |
VAERS Form: | |
Age: | 0.3 |
Sex: | 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
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
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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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