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This is VAERS ID 309002

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 309002
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, CSF culture negative

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, /"the patient was"brought into the office at 5 months old and was lethargic./" On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to b


Changed on 12/8/2009

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type': (blank) WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, /"the "the patient was"brought was brought into the office at 5 months old and was lethargic./" lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to b be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 3/2/2010

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 4/7/2010

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 8/31/2010

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 4/13/2011

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 5/13/2011

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 6/11/2011

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 5/13/2013

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 1 RA / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 4/14/2017

VAERS ID: 309002 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 1 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Body temperature increased, C-reactive protein increased, Chest X-ray normal, Computerised tomogram normal, CSF culture negative, Culture urine negative, Dehydration, Gastrointestinal necrosis, Intussusception, Laparotomy, Lethargy, Lymphadenitis, Lymphocyte count increased, Nausea, Small intestinal resection, Somnolence, Upper respiratory tract infection, Vomiting, Weight decreased, Red blood cell sedimentation rate increased, Enema administration, Neutrophil percentage increased, Intestinal resection, Intestinal anastomosis, Urine output decreased, Decreased appetite

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, per persistent intussusception at level of proximal mid ascending colon is noted. CT brain unremarkable. CXR: normal. Blood, urine and CSF culture no growth. CRP increased 2.9. Neutrophil % increased 47, lymphocytes increased 4.9, sed rate increased 29.
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 9/14/2017

VAERS ID: 309002 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 1 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 1 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Intestinal resection

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, persistent intussusception at level of proximal mid ascending colon is noted. CT brain unremarkable. CXR: normal. Blood, urine and CSF culture no growth. CRP increased 2.9. Neutrophil % increased 47, lymphocytes increased 4.9, sed rate increased 29.
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 2/14/2018

VAERS ID: 309002 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Intestinal resection

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, persistent intussusception at level of proximal mid ascending colon is noted. CT brain unremarkable. CXR: normal. Blood, urine and CSF culture no growth. CRP increased 2.9. Neutrophil % increased 47, lymphocytes increased 4.9, sed rate increased 29.
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 6/14/2018

VAERS ID: 309002 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Intestinal resection

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, persistent intussusception at level of proximal mid ascending colon is noted. CT brain unremarkable. CXR: normal. Blood, urine and CSF culture no growth. CRP increased 2.9. Neutrophil % increased 47, lymphocytes increased 4.9, sed rate increased 29.
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 8/14/2018

VAERS ID: 309002 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Intestinal resection

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, persistent intussusception at level of proximal mid ascending colon is noted. CT brain unremarkable. CXR: normal. Blood, urine and CSF culture no growth. CRP increased 2.9. Neutrophil % increased 47, lymphocytes increased 4.9, sed rate increased 29.
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 9/14/2018

VAERS ID: 309002 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Intestinal resection

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, persistent intussusception at level of proximal mid ascending colon is noted. CT brain unremarkable. CXR: normal. Blood, urine and CSF culture no growth. CRP increased 2.9. Neutrophil % increased 47, lymphocytes increased 4.9, sed rate increased 29.
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


Changed on 10/14/2018

VAERS ID: 309002 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Texas
Vaccinated:2007-03-20
Onset:2007-04-07
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastrointestinal necrosis, Intussusception, Lethargy, Intestinal resection

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, persistent intussusception at level of proximal mid ascending colon is noted. CT brain unremarkable. CXR: normal. Blood, urine and CSF culture no growth. CRP increased 2.9. Neutrophil % increased 47, lymphocytes increased 4.9, sed rate increased 29.
CDC 'Split Type': WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.

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