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This is VAERS ID 314720

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 314720
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45153 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Blood creatinine decreased, Blood urea decreased, Diet refusal, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enem
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus b"loody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 12/8/2009

VAERS ID: 314720 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45153 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Blood creatinine decreased, Blood urea decreased, Diet refusal, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Lethargy, Lymphocyte count decreased, Mucous stools, Neutrophil count increased, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enem
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus b"loody bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 3/2/2010

VAERS ID: 314720 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45153 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Blood creatinine decreased, Blood urea decreased, Diet refusal, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Lethargy, Lymphocyte count decreased, Mucous stools, Neutrophil count increased, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enem
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 4/7/2010

VAERS ID: 314720 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45153 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Blood creatinine decreased, Blood urea decreased, Diet refusal, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Lethargy, Lymphocyte count decreased, Mucous stools, Neutrophil count increased, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enem
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 8/31/2010

VAERS ID: 314720 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45153 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Blood creatinine decreased, Blood urea decreased, Diet refusal, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Lethargy, Lymphocyte count decreased, Mucous stools, Neutrophil count increased, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enem
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 5/13/2013

VAERS ID: 314720 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Blood creatinine decreased, Blood urea decreased, Diet refusal, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Lethargy, Lymphocyte count decreased, Mucous stools, Neutrophil count increased, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enem
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 4/14/2017

VAERS ID: 314720 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Blood creatinine decreased, Blood urea decreased, Diet refusal, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Lethargy, Lymphocyte count decreased, Mucous stools, Neutrophil count increased, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enem enema. Post op abdominal pain with repeat ultrasound negative.
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 9/14/2017

VAERS ID: 314720 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enema. Post op abdominal pain with repeat ultrasound negative.
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 2/14/2018

VAERS ID: 314720 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enema. Post op abdominal pain with repeat ultrasound negative.
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 6/14/2018

VAERS ID: 314720 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enema. Post op abdominal pain with repeat ultrasound negative.
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 8/14/2018

VAERS ID: 314720 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enema. Post op abdominal pain with repeat ultrasound negative.
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 9/14/2018

VAERS ID: 314720 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enema. Post op abdominal pain with repeat ultrasound negative.
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


Changed on 10/14/2018

VAERS ID: 314720 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-03-26
Onset:2008-05-19
Submitted:2008-05-29
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enema. Post op abdominal pain with repeat ultrasound negative.
CDC 'Split Type':

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.

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