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Found 753 cases where Vaccine is RV5 and Symptom is Intussusception and Appearance Date on/before '2012-04-30'

Case Details

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VAERS ID: 295492 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Ohio  
Vaccinated:2007-09-13
Onset:2007-10-01
   Days after vaccination:18
Submitted: 2007-11-02
   Days after onset:32
Entered: 2007-11-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0078U / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510E / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US showed small bowel intussuception. Air enema unsuccessful in reducing IS. Stool cx and Rotavirus on 10/11/07 (-).
CDC Split Type: WAES0710USA05838

Write-up: Information has been received from a physician concerning a 4-month-old patient who in 2007 was vaccinated PO with the second dose of Rotateq. The physician reported that in October 2007, the patient developed intussusception and was hospitalized. Surgery was performed and the patient subsequently recovered. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 11/09/2007 Vax record received from PCP and info updated in VAERS database. Lot number for 9/13/07 Rotateq verified as 1116F. 11/28/2007 MR received for DOS 9/24-30/2007 with principal DX: Intussusception. 2'' DX: Transverse colon perforation. Bilateral Inguinal hernias. Child presented to ED after transfer from local ED with vomiting, diarrhea, no po intake that day and decreased UOP. Concern for IS on US. Attempted reduction of IS by air enema resulted in perforation and pt was taken to OR for an Exploratory lap, reduction of ileocolic Intussusception and repair of transverse colon perforation. Pneumoperitoneum reduced by angiocath. Pt progressed well post-op and was D/cd on POD #6. 01/07/2008 Additional records received for ER visit 10/8/07 with C/o fever and mucusy stools with DX: viral GE. F/U OV 10/11/07 with c/o diarrhea. Assessment Viral syndrome s/p Intussusception.


VAERS ID: 295494 (history)  
Form: Version 1.0  
Age: 0.67  
Gender: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2007-10-04
Submitted: 2007-11-02
   Days after onset:29
Entered: 2007-11-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception
SMQs:, Gastrointestinal obstruction (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA05309

Write-up: Information has been received from a physician concerning an 8 month old male who received his third 2.0 ml oral dose of Rotateq. On 04-OCT-2007, the patient developed intussusception. The patient sought unspecified medical attention and has recovered. A product quality complaint was not reported. No further information was available. Upon internal review intussusception was determined to be an other important medical event. Additional information has been requested.


VAERS ID: 296290 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: New York  
Vaccinated:2007-10-31
Onset:2007-11-06
   Days after vaccination:6
Submitted: 2007-11-09
   Days after onset:3
Entered: 2007-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B194AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B50007A / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0876U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC Split Type:

Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


VAERS ID: 296422 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: South Carolina  
Vaccinated:2007-06-05
Onset:2007-06-08
   Days after vaccination:3
Submitted: 2007-11-09
   Days after onset:154
Entered: 2007-11-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B113AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435T / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0241U / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal tenderness, Blood test normal, Body temperature increased, Culture stool negative, Diarrhoea, Gastrointestinal sounds abnormal, Haematochezia, Intussusception, Laboratory test abnormal, Lethargy, Mucous stools, Somnolence, Surgery, Urinary system X-ray, Urine output decreased, Vomiting
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: KUB X-ray 06/11/07 - decreased air in colon, diagnostic laboratory 06/10/07 - decreased bowel sounds, doughy abdomen; laboratory test 06/10/07 - bloodwork, stool culture 06/11/07 - negative. Labs and Diagnostics: Abd X-ray with non-specific gas pattern. ? hepatomegaly. Stool cx (-) with occ WBCs. UC (-). Blood cx (-). CBC with WBCs 9.3. BMP with bicarb 18. Labs and Diagnostics: Contrast enema (+) for IS, partially reduced. Surgical path report noted Cecum with mucosal hemorrhage and necrosis, c/w ischemic injury.
CDC Split Type: WAES0711USA00221

Write-up: Information has been received from a physician concerning a 17 week old female who in April 2007 and June 2007, was vaccinated PO with her first and second (lot# 656705/0241U) doses of Rotateq. Vaccinations at two months of age included "other 2 month recommended vaccines." On 05-JUL-2007 the patient was diagnosed with intussusception, was hospitalized and underwent emergency surgery. Subsequently, the patient recovered. It was noted that the patient did not have any adverse experience after the first dose two months earlier. There was no product quality complaint. The event was also considered to be an other important medical event (surgery) by the reporter. Follow-up information has been received from a physician indicating that the patient was vaccinated on 03-APR-2007 and 05-JUN-2007 with the first (lot# 655483/1116F) and second dose of Rotateq. Concomitant vaccinations administered on 05-JUN-2007 included a dose of PedvaxHIB, a dose of Pediarix and a dose of Prevnar. On 08-JUN-2007 the course of events were as follows: the patient had a two day history of diarrhea, non-bloody vomiting, decreased urinary output, was lethargic and sleepy, and had a low grade temperature. The patient presented to the emergency room on 10-JUN-2007 and was given fluids, blood work was done (results and specific tests not provided). On exam the patient had decreased bowel sounds and a doughy abdomen. A KUB was performed and showed decreased air in the colon. The passed a bloody mucous jelly stool in the ER. The patient was then transferred from the ER to another hospital for evaluation of intussusception. The patient was admitted to the hospital on 11-JUN-2007 and underwent surgery. Stool cultures performed while the patient was hospitalized were negative. The physician stated that the patient is "fine." On approximately 01-JUL-2007 (in the beginning of July), the patient seen by the surgeon who reported that the intussusception was "completely resolved." It was also noted that the surgeon "did not anticipate further problems." Additional information has been requested. 11/15/2007 Vax record received from PCP and info updated in VAERS database. 12/21/2007 MR received for DOS 6/11/2007 with DX: Acute Gastroenteritis. Dehydration. Somewhat lethargic. Child presented to ER with 2 day hx of diarrhea, vomiting, low grade fever, and decreased UO and energy level. PE (+) for sleepiness, doughy abdomen with decreased BS, and a tubular mass in the LUQ. Bloody stool noted during admission, but pt D/C same day. No D/C Summ written. Child transfered to higher level of care. 12/31/07 MR received from transfer facility for DOS 6/11-14/2007 with primary DX: Cecal polyp from ischemia. Presented as above. IS noted on contrast enema, partially reduced. Taken to OR for exploratory lap for Intussusception. IS was reduced. Polyp noted in ileocecal valve which appeared to be acting as lead point. A limited ileoceccectomy was also performed. D/C on post-op day 3 in stable cond.


VAERS ID: 297390 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Texas  
Vaccinated:2007-09-21
Onset:2007-10-31
   Days after vaccination:40
Submitted: 2007-11-19
   Days after onset:19
Entered: 2007-11-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B0976B / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08697C / 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02424 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC Split Type: WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.


VAERS ID: 297542 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Unknown  
Vaccinated:2007-08-23
Onset:2007-11-06
   Days after vaccination:75
Submitted: 2007-11-20
   Days after onset:14
Entered: 2007-11-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Haematochezia, Intussusception, Laboratory test, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC Split Type: WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is "doing fairly well now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


VAERS ID: 297890 (history)  
Form: Version 1.0  
Age: 0.39  
Gender: Female  
Location: South Carolina  
Vaccinated:2007-09-21
Onset:2007-10-29
   Days after vaccination:38
Submitted: 2007-11-26
   Days after onset:28
Entered: 2007-11-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 2 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC Split Type: WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


VAERS ID: 298203 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: Florida  
Vaccinated:2007-09-26
Onset:2007-11-24
   Days after vaccination:59
Submitted: 2007-11-28
   Days after onset:4
Entered: 2007-11-29
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF163AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: congestion, rhinnorhea, cough & ear infection 3 wks prior tx w/antibiotics last dose 11/23.
Allergies:
Diagnostic Lab Data: Ultrasound showed telescoping of bowel segments. LABS: US revealed IS in right periumbilical region. Air contrast enema reduced IS.
CDC Split Type:

Write-up: Intussusception diagnosed by ultrasound after patient presented with vomiting and bloody stools. 12/04/07 Reviewed vax record which confirms RO dose/lot as reported. Faxed to CDC. 12/18/07 Reviewed hospital medical records which reveal patient experienced irritability, reduced oral intake, vomiting, abdominal pain & bloody stools. Taken to ER 11/24/07. Admitted for observation overnight. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


VAERS ID: 298456 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: California  
Vaccinated:2007-11-09
Onset:2007-11-20
   Days after vaccination:11
Submitted: 2007-11-30
   Days after onset:10
Entered: 2007-12-03
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0255U / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abnormal faeces, Barium enema, Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: antimicrobial (unspecified)
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 11/??/07 4/15/08 Received additional lab reports from CDC: appendix revealed extensive ulcerated mucosa w/necrosis & fibromucopurulent debris in lumen, mixed inflammatory cell infiltrates & hemorrhage. Testing for adenovirus & rotavirus were neg.
CDC Split Type: WAES0711USA04977

Write-up: Information has been received from a physician concerning a 4 month old female who on approximately 06-NOV-2007 was vaccinated PO with the second 2.0 ml dose of Rotateq (no lot number provided). Concomitant drug therapy included "antimicrobial (unspecified)." On 20-NOV-2007 two and a half weeks after being vaccinated, the patient experienced intussusception characterized by an abnormal stool and was hospitalized for a total of 3 days. A barium enema test was performed and the patient underwent surgery to repair the intussusception." On 23-NOV-2007 the patient was released from the hospital. Subsequently, the patient recovered. There was no product quality complaint. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 1/11/08 Reviewed hospital medical records which reveal patient experienced irritability, black stools & bilious emesis x 12 hours which progressed to bloody stools. Went to outlying ER where gastrograffin enema reveals IS that could not be reduced despite 3 attemps. Transferred to higher level of care for surgical management. Admitted 11/20-11/23/2007. On admit, lethargic, distended abdomen w/epigastric mass palpablel. To OR for exp lap, no bowel resection needed. Did well post op & d/c to home. Final DX: intussusception, surgically reduced. 1/22/08 Reviewed vax record.


VAERS ID: 298501 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Female  
Location: Ohio  
Vaccinated:2007-09-18
Onset:2007-11-19
   Days after vaccination:62
Submitted: 2007-12-03
   Days after onset:14
Entered: 2007-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS PAC21B097AB / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF108AA / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: extreme crying, high pitched crying~DTaP + HepB + IPV (Pediarix)~1~0.20~Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: x-rays, CT scans, surgery 1/9/08-records received-CT abnormal. Barium enema unsuccessful attempt at reduction of intussusception at approximately the level of the distal ascending colon near the level of hepatic flexure.
CDC Split Type:

Write-up: 11/19/07 began with abd. pain and vomiting. taken to ER in Findlay in evening, discharged to home when vomiting ceased. symptoms continued that week and febrile suppositories given. on 11/24/07 taken to PCACC and xray, CT scan done. transferred to Hospital and had surgery for intusseption. 1/9/08-records received for DOS 11/24-11/28/07. DC DX: Intussusception. Laproscopic reduction of ileocolonic intussusception. Five days prior to admission developed abdominal pain and emesis. Bowel movement present with bloody mucus 2-3 days prior to admission.


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