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This is VAERS ID 320442

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 320442
VAERS Form:
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B540140 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Anion gap increased, Barium enema abnormal, Blood bicarbonate decreased

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-N"OV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no p


Changed on 12/8/2009

VAERS ID: 320442 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B540140 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal distension, Abdominal mass, Anion gap increased, Barium enema abnormal, Blood bicarbonate decreased, Computerised tomogram, Haematemesis, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Vomiting, Enema administration, X-ray gastrointestinal tract abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': (blank) WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-N"OV-2007. 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no p product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 3/2/2010

VAERS ID: 320442 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B540140 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal mass, Anion gap increased, Barium enema abnormal, Blood bicarbonate decreased, Computerised tomogram, Haematemesis, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Vomiting, Enema administration, X-ray gastrointestinal tract abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 4/7/2010

VAERS ID: 320442 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B540140 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal mass, Anion gap increased, Barium enema abnormal, Blood bicarbonate decreased, Computerised tomogram, Haematemesis, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Vomiting, Enema administration, X-ray gastrointestinal tract abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 8/31/2010

VAERS ID: 320442 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B540140 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal mass, Anion gap increased, Barium enema abnormal, Blood bicarbonate decreased, Computerised tomogram, Haematemesis, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Vomiting, Enema administration, X-ray gastrointestinal tract abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 5/13/2013

VAERS ID: 320442 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540140 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal mass, Anion gap increased, Barium enema abnormal, Blood bicarbonate decreased, Computerised tomogram, Haematemesis, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Vomiting, Enema administration, X-ray gastrointestinal tract abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 4/14/2017

VAERS ID: 320442 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540140 / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal mass, Anion gap increased, Barium enema abnormal, Blood bicarbonate decreased, Computerised tomogram, Haematemesis, Haematochezia, Inappropriate schedule of drug administration, Intussusception, Vomiting, Enema administration, X-ray gastrointestinal tract abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 9/14/2017

VAERS ID: 320442 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 1 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540140 / 1 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 2/14/2018

VAERS ID: 320442 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540140 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 6/14/2018

VAERS ID: 320442 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540140 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 8/14/2018

VAERS ID: 320442 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540140 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 9/14/2018

VAERS ID: 320442 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540140 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.


Changed on 10/14/2018

VAERS ID: 320442 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Kansas
Vaccinated:2008-03-05
Onset:2008-03-05
Submitted:2008-07-24
Entered:2008-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF20849B / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540140 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: BE (+) for IS. Upper GI (+) for dilated bowel loops c/w obstruction. Abdominal CT obscured by barium. BMP with bicarb 15 and anion gap of 18. Stool and gastric occult blood (+).
CDC 'Split Type': WAES0807USA03859

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 05-MAR-2008 was vaccinated orally with a second 2ml dose of ROTATEQ (lot # 659775/1664U). The first dose of ROTATEQ (lot # 657518/1192U) was administered on 18-NOV-2007. Subsequently, on 27-APR-2008 the patient had intussusception and was hospitalized until 29-APR-2008. It was unspecified if lab studies were performed. A surgical correction was done and the patient recovered on an unspecified date. There was no product quality complaint involved. Additional information has been requested. 8/11/2008 MR received for DOS 4/28-29/2008 with D/C DX: Intussusception. Infant presented with 24 hr hx of frequent emesis, intermittantly green with blood. Fussy for several days prior to admit. Later had bloody stool in hospital. Surgical consult noted fullness to abdomen with mass effect on R. BE done which identified and reduced an ileocecal IS. PO advanced post-procedure, tolerated well.

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