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This is VAERS ID 320886

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 320886
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal distension, Barium enema abnormal, Blood bicarbonate decreased, Blood chloride increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 wi"th D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt


Changed on 12/8/2009

VAERS ID: 320886 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal distension, Barium enema abnormal, Blood bicarbonate decreased, Blood chloride increased, Blood potassium increased, Blood sodium normal, Carbon dioxide decreased, Dehydration, Electrolyte imbalance, Full blood count, Haematochezia, Haematocrit decreased, Ileus, Intestinal obstruction, Intestinal perforation, Intussusception, Surgery, Vomiting, White blood cell count, X-ray with contrast upper gastrointestinal tract, Enema administration, Leukocyturia, Ultrasound abdomen, Fontanelle depressed, Explorative laparotomy, Intestinal resection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 wi"th with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.


Changed on 5/13/2013

VAERS ID: 320886 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Barium enema abnormal, Blood bicarbonate decreased, Blood chloride increased, Blood potassium increased, Blood sodium normal, Carbon dioxide decreased, Dehydration, Electrolyte imbalance, Full blood count, Haematochezia, Haematocrit decreased, Ileus, Intestinal obstruction, Intestinal perforation, Intussusception, Surgery, Vomiting, White blood cell count, X-ray with contrast upper gastrointestinal tract, Enema administration, Leukocyturia, Ultrasound abdomen, Fontanelle depressed, Explorative laparotomy, Intestinal resection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.


Changed on 4/14/2017

VAERS ID: 320886 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Barium enema abnormal, Blood bicarbonate decreased, Blood chloride increased, Blood potassium increased, Blood sodium normal, Carbon dioxide decreased, Dehydration, Electrolyte imbalance, Full blood count, Haematochezia, Haematocrit decreased, Ileus, Intestinal obstruction, Intestinal perforation, Intussusception, Surgery, Vomiting, White blood cell count, X-ray with contrast upper gastrointestinal tract, Enema administration, Leukocyturia, Ultrasound abdomen, Fontanelle depressed, Explorative laparotomy, Intestinal resection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.


Changed on 9/14/2017

VAERS ID: 320886 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Carbon dioxide decreased, Intestinal obstruction, Intussusception, Surgery, Vomiting, Leukocyturia, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.


Changed on 2/14/2018

VAERS ID: 320886 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Carbon dioxide decreased, Intestinal obstruction, Intussusception, Surgery, Vomiting, Leukocyturia, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.


Changed on 6/14/2018

VAERS ID: 320886 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Carbon dioxide decreased, Intestinal obstruction, Intussusception, Surgery, Vomiting, Leukocyturia, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.


Changed on 8/14/2018

VAERS ID: 320886 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Carbon dioxide decreased, Intestinal obstruction, Intussusception, Surgery, Vomiting, Leukocyturia, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.


Changed on 9/14/2018

VAERS ID: 320886 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Carbon dioxide decreased, Intestinal obstruction, Intussusception, Surgery, Vomiting, Leukocyturia, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.


Changed on 10/14/2018

VAERS ID: 320886 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-07-21
Onset:2008-07-25
Submitted:2008-07-30
Entered:2008-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0413X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Carbon dioxide decreased, Intestinal obstruction, Intussusception, Surgery, Vomiting, Leukocyturia, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levsin drops PRN
Current Illness: None
Preexisting Conditions: Colic (intermittent); history of milia. PMH: none. NKDA
Allergies:
Diagnostic Lab Data: Low CO2, Leukocyturia, Abnormal Abdominal Films. Labs and Diagnostics: CBC with WBC 13, Hct 32. Electrolytes abnormal with Na+ 144, K+ 9, Cl- 114, bicarb 12. Barium enema (+) for ileocolic IS and bowel perf. Upper GI. US.
CDC 'Split Type':

Write-up: Patient had emesis x 5-7 episodes 4 days after ROTATEQ vaccination; diagnosed with obstruction due to INTUSSUSCEPTION; required surgery to relieve obstruction and removal of small segment of ascending colon. 08/27/2008 MR received for DOS 7/26-30/2008 with D/C DX: Intussusception. Pt presented with several day hx of vomiting with dehydration. Pt had bloody stool during eval. PE (+) for depressed fontanelle and abdominal distention. Enema attempted for reduction which resulted in a bowel perforation. Pt taken for emergent exploratory lap with small bowel resection of perforated segment with primary anastomosis. Pt developed mild ileus post-op which resolved spontaneously and diet then advanced.

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