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This is VAERS ID 337444

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 337444
VAERS Form:
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC DL6279 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Barium enema abnormal, Constipation, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 3/2/2010

VAERS ID: 337444 Before After
VAERS Form:
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC DL6279 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Barium enema abnormal, Constipation, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 4/7/2010

VAERS ID: 337444 Before After
VAERS Form:
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC DL6279 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Barium enema abnormal, Constipation, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 8/31/2010

VAERS ID: 337444 Before After
VAERS Form:
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH DL6279 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Barium enema abnormal, Constipation, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 5/13/2013

VAERS ID: 337444 Before After
VAERS Form:
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Barium enema abnormal, Constipation, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 4/14/2017

VAERS ID: 337444 Before After
VAERS Form:
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Barium enema abnormal, Constipation, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Urine output decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 9/14/2017

VAERS ID: 337444 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 2/14/2018

VAERS ID: 337444 Before After
VAERS Form:1
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 6/14/2018

VAERS ID: 337444 Before After
VAERS Form:1
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 8/14/2018

VAERS ID: 337444 Before After
VAERS Form:1
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 9/14/2018

VAERS ID: 337444 Before After
VAERS Form:1
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


Changed on 10/14/2018

VAERS ID: 337444 Before After
VAERS Form:1
Age:0.2
Gender:Unknown
Location:Unknown
Vaccinated:2008-12-04
Onset:2009-01-06
Submitted:2009-01-14
Entered:2009-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC 'Split Type': WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .

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