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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: 344361 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Florida  
Vaccinated:2009-02-17
Onset:2009-04-12
   Days after vaccination:54
Submitted: 2009-04-17
   Days after onset:5
Entered: 2009-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF575AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87310 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Air Enema
CDC Split Type:

Write-up: Intussusception 4/29/09 Received hospital medical records of 4/13-4/15/2009. FINAL DX: Intussusception, enema reduced Records reveal patient experienced bilious vomiting & bloody stools. Admitted for observation s/p enema reduction, progressed well & d/c to home.


VAERS ID: 344817 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Nebraska  
Vaccinated:2009-04-07
Onset:2009-04-12
   Days after vaccination:5
Submitted: 2009-04-24
   Days after onset:12
Entered: 2009-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3290AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D37016 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1652X / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Enema administration, Intussusception, Irritability, Listless, Ultrasound abdomen abnormal, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Runny nose x 1 day
Preexisting Conditions: None PMH: 37 wk gestation, no complications. GERD.
Allergies:
Diagnostic Lab Data: Abdominal US & X-ray; XR enema for intussusception LABS: abdominal x-ray & US abnormal.
CDC Split Type:

Write-up: Intussusception, Bilious vomiting, Irritability, Listlessness. Intermittent vomiting episodes starting on 4-12-09. Increased vomiting noted on 4-21-09. Diagnosed with intussusception on 4-23-09. 5/6/09 Received hospital medical records of 4/23-4/24/2009. FINAL DX: Intussusception, enema reduced Records reveal patient experienced bilious vomiting, irritability, decreased appetite, listlessness x 1 day. Had experienced projectile vomiting x 1 day 2 wks prior & 1 wk prior. Seen in Urgent Care & dx w/gastroenteritis & viral pharyngitis. Vomiting persisted & seen in ER wehre IS dx. Air contrast enema reduced IS but continued to have considerable bowel edema. Surgery consult done. Admitted for observation.


VAERS ID: 345072 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Ohio  
Vaccinated:2009-04-13
Onset:2009-04-26
   Days after vaccination:13
Submitted: 2009-04-28
   Days after onset:2
Entered: 2009-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3084AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF579AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D21053 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1473X / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Enema administration, Intussusception, X-ray
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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound; XR fluoro air enema. 6/8/09 Hospital records DC summary received DOS 4/27/09 to 4/28/09. LABS and DIAGNOSTICS: Ultrasound. CHEM WNL. CBC - WBC 14.9 10x3/mm3 (H). PLT 599 10x3/mm3 (H) Atypical Lymphocytes 1+ ANISO 1+. Fluoroscopy - air enema reduction of ileocolic intussusception.
CDC Split Type:

Write-up: Intussusception reduced 5/04/09 Received vaccine & PCP medical records of 4/13-4/27 as well as hospital d/c summary of 4/27-4/28/2009. FINAL DX: Intussusception, enema reduced Records reveal patient experienced projectile vomiting, irritability, decreased appetite, sleep disturbance, sunken eyes x 2 days. Tx w/air enema & admitted overnight for observation. Progressed well & d/c home. 6/8/09 Hospital records DC summary received DOS 4/27/09 to 4/28/09. FINAL DIAGNOSIS: Intussusception, reduced with air enema. Post vaccination: Fussiness, not sleeping well. Projectile emesis, knees flexed. Admitted to hospital with abdominal pain and intermittant vomiting. Reduction by air enema. ICD-9 Codes: 5600 Intussusception.


VAERS ID: 345976 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: California  
Vaccinated:2009-01-30
Onset:2009-03-05
   Days after vaccination:34
Submitted: 2009-03-16
   Days after onset:10
Entered: 2009-05-08
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF264AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1168X / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Intussusception, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None 5/21/09 medical records PMH: ear infection 1/09.
Allergies:
Diagnostic Lab Data: 5/21/09 ER medical records LABS: UA abnormal w/protein & ketones. CMP WNL. WBC 20.8(H), plts 532(H), neutros 70%(H), lymphs 21%(L). 6/2/09 additional hospital records received DOS 3/8/09 to 3/13/09. LABS and DIAGNOSTICS: X-RAY Abdomen - Dilated loops of bowel. X-RAY Chest - Bowel gas. X-RAY Barium Enema - Unable to reduce intussusception. Blood culture - no growth. MRSA Screen (-). CHEM - Glucose 153 mg/dL (H). Alkaline Phosphatase 110 U/L (L). CBC - Platelet Count 474 K/uL (H) Neurophils 66% (H) Lymphocytes 22% (L) Neutrophils 9.6 K/uL (H). Path Report - Cecal Appendix.
CDC Split Type:

Write-up: Child received oral Rotavirus vaccine Jan 30 2009. Had some nausea, vomiting, fever for 24 Hrs then resolved but 5 1/2 wk later developed intussusception requiring surgery on 03-05-09. 6/2/09 additional hospital records, including operative report, received DOS 3/8/09 to 3/13/09. FINAL DIAGNOSIS: Intussusception not reduced with air enema. Post vaccination presents with several day history of vomiting and no stool output. Lethargic. Distended abdomen with palpable mass in the RLQ. Lethargic. Ileocolic intussusception surgically reduced. ICD-9 Codes: 560.0 Intussusception of Intestine, 27651 Dehydration, 46.82 Intra-abdominal manipulation of large intestine, 47.19 Incidental Appendectomy NEC. 5/21/09 Received ER medical records of 3/7 & 3/8/2009. FINAL DX: voomiting w/dehydration Records reveal patient had vomiting, decreased oral intake, decreased urine output, decreased activity, listless, sleepiness, nasal discharge/congestion x 1 day when seen 3/7. Tx w/IVF & antiemetic. Improved & d/c to home. Vomiting continued, developed projectile vomiting, lethargy & returned to ER on 3/8 FINAL DX: vomiting w/mod dehydration & volume depletion Tx w/antiemetic & IVF. Improved but transferred to higher level of care. 5/26/09 Received hospital d/c summary of 3/8-3/13/2009. FINAL DX: exp laparotomy for reduction of intussusception; dehydration, resolved. Records reveal patient experienced lethargy, RLQ mass, constipation. Surgery consult done & taken to OR on 3/9. Progressed well & d/c to home.


VAERS ID: 346574 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Texas  
Vaccinated:2009-05-07
Onset:2009-05-11
   Days after vaccination:4
Submitted: 2009-05-18
   Days after onset:7
Entered: 2009-05-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3290AA / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34347 / UNK LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0284Y / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. 6/12/09 Hospital records and DC summary received DOS 5/11/09 t0 5/12/09. Surgery for pyloric stenosis - pyloromyotomy, umbilical abcess - MRSA, umbilical hernia repair, GERD.
Allergies:
Diagnostic Lab Data: Unknown. 6/12/09 Hospital records and DC summary received DOS 5/11/09 t0 5/12/09. LABS and DIAGNOSTICS: KUB - intussusception. Ultrasound Abdomen - intussusception. Barium air contrast enema - intussusception. CBC - RDWCV 12.2% (L) RDWSD 35.6 FL (L) Platelet - 556 10^3/UL (H) Mono 14.2% (H) IG(Immature Granulocytes)% 0.6% (H). CHEM - Glucose 67 MG/DL (L).
CDC Split Type: WAES0905USA01445

Write-up: Information has been received from a physician concerning an approximately 17 week old male who was vaccinated orally with a 2 ml second dose of ROTATEQ. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. On 11-MAY-2009 the patient was admitted into the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 6/12/09 Hospital records and DC summary received DOS 5/11/09 t0 5/12/09. FINAL DIAGNOSIS: Intussusception. Post vaccination abdominal pain, emesis, decreased oral intake. No BM for 2 days. Crying, fussy. Successful reduction with barium air contrast enema. ICD-9 Codes: 5600, 53081


VAERS ID: 346575 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: California  
Vaccinated:2008-07-14
Onset:2009-05-11
   Days after vaccination:301
Submitted: 2009-05-18
   Days after onset:7
Entered: 2009-05-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B153AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C05368 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0502X / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown. 6/4/09 Hospital records received DOS 5/11/09. Motrin.
Current Illness:
Preexisting Conditions: Unknown 11/12/08 received flu vaccine, SP lot # UT2782CD, IM/LT.
Allergies:
Diagnostic Lab Data: Unknown LABS: KUB abnormal. Air contrast enema reduced IS. 6/4/09 Hospital records received DOS 5/11/09. LABS and DIAGNOSTICS: CHEM - Sodium 144 mmol/L (H). Abdominal X-ray - abnormal soft tissue density over right colon. Reduce Intussusception X-Ray - slight delay at iliocecal valve.
CDC Split Type: WAES0905USA01453

Write-up: Information has been received from a physician concerning a patient who on an unspecified dates was vaccinated orally with three doses of ROTATEQ. Subsequently the patient was diagnosed with intussusception. The patient visited the physician''s office for medical attention. At the time of reporting, the outcome was unknown. Upon internal review intussusception was considered to be an other important medical events. Additional information has been requested. 5/21/09 Received vaccine & PCP medical records which included hospital H&P. FINAL DX: Intussusception, enema reduced Records reveal patient experienced abdominal pain & decreased energy x 1 day. Had URI & loose stools x 1 wk. Saw PCP on 5/11 & sent to ER. Observed overnight s/p enema reduction. Improved & d/c to home. 6/4/09 Hospital records received DOS 5/11-12/09. FINAL DX: Intussusception, enema reduced. Post vaccination acute onset of abdominal pain. Loose stools. Decreased energy. Rhinorrhea and cough. 8/27/09 Received ICD9 codes for 5/11-5/12 admit: 560.0, intussusception; 465.9 acute URI NOS; 789.00 abdominal pain, unspecified site.


VAERS ID: 347013 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: California  
Vaccinated:2009-04-06
Onset:2009-04-08
   Days after vaccination:2
Submitted: 2009-05-22
   Days after onset:44
Entered: 2009-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16282 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Enema administration, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE KNOWN
Current Illness: NONE KNOWN, SEEN FOR IMMZ ONLY.
Preexisting Conditions: NONE KNOWN Family hx: TB, currently being tx.
Allergies:
Diagnostic Lab Data: Sent in ER for KUB, 2 view (paucity of bowel gas in lower quadrants), then send to radiology for air contrast/enema. Exploritory laparotomy preformed. Pt admitted, and taken to OR for reduction of intussusception and poss removal of necrotic bowel. Very difficult reduction intussusception, pt kept in hosp for 1 week following surgery because of concerns regarding the bowels. Pt did well. Diet good, no fever or prob with intestines. As of May 1, 2009, pt still doing well. Tolerating diet, normal bowels without signs of bleeding. Incision healed with no signs of hernia or infection. 6/15/09 Hospital LABS: CRP 1.8(H). Abdominal x-ray abnormal.BE dx IS but unable to completely reduce.
CDC Split Type:

Write-up: Pt received Rotavirus vaccine on 4/06/09. Pt had ER visit with Dx intussusception on 4/08/09. pt c/o vomiting/rectal bleeding, low grade fever. Moc + PPD, taking INH/Vit B-12. 6/8/09 Medical records received DOS 4/6/09 to 4/20/09. FINAL DIAGNOSIS: Reduction of Intussusception. Post vaccination presented with fever, emesis, crying and arching back. R TN obscured. Diarrhea. Referred to hospital for evaluation, reduction of intussusception. 6/15/09 Received hospital medical records for 4/8-4/15/2009. FINAL DX: intussusception, open reduction w/appendectomy Records reveal patient experienced vomiting, decreased appetite, irritable, lethargic, bloody stools, cramping, abdominal pain, low grade fever x 1 day. Attempted enema reduction unsuccessful. Surgical consult done. To OR for difficulty manual reduction. Bowel noted to have edema & hemorrhage but no frank necrosis. Developed cough & fever postoperatively which resolved by d/c to home.


VAERS ID: 347026 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Georgia  
Vaccinated:2009-03-27
Onset:2009-04-07
   Days after vaccination:11
Submitted: 2009-05-22
   Days after onset:45
Entered: 2009-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF579AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D33126 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1661X / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium double contrast, Enema administration, Intussusception
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? No
Previous Vaccinations:
Other Medications: None. 6/5/09 Medical records received DOS 4/30/09 to 5/1/09. Ondansetron, LMX.
Current Illness: None Known
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Reduced with air contrast enema. 6/5/09 Medical records received DOS 4/30/09 to 5/1/09. CHEM: CL 107 MMOL/L (H). POC Glucose - 110 mg/d/L. Occult blood stool (-). 6/5/09 Discharge summary received DOS 5/1/09. X-ray Abdomen - gas-filled loops of bowel. X-ray abdomen / air enema - successful reduction of intussusception.
CDC Split Type:

Write-up: Baby was brought in today by her mother. Mom reported to the doctor about SXs 30 days after her 1st dose of ROTATEQ. Intussusception per Dr. . Reduced with air contrast enema. 6/5/09 Medical records received DOS 4/30/09 to 5/1/09. FINAL DIAGNOSIS: Intussusception, dehydration, vomiting. Post vaccination presented with vomiting, face swelling, tugging at ears. Decreased intake liquids. Crying. Difficulty waking up. 6/5/09 Discharge summary received DOS 5/1/09. FINAL DIAGNOSIS: Intussusception Post vaccination presented with crampy abdominal pain and bloody stools. Vomiting.


VAERS ID: 348258 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Tennessee  
Vaccinated:2009-03-30
Onset:2009-04-03
   Days after vaccination:4
Submitted: 2009-06-01
   Days after onset:59
Entered: 2009-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3163AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D18704 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: none
Current Illness: none
Preexisting Conditions: Reactive airway disease and eczema
Allergies:
Diagnostic Lab Data: heme positive stool, positive barium enema 6/2/09 ER records received DOS 4/3/09. LABS and DIAGNOSTICS: CBC - WBC WNL, Decreased Hemoglobin 7.9 G/DL, Decreased Hematocrit 26.4%, Elevated Platelets 698 TH/MM3. CHEM: Elevated Chloride 108 MMOL/L - otherwise WNL. X-Ray Abdomen - Lack of gas in colon with small bowel distention. 6/10/09 Hospital records / DC summary received DOS 4/3/09 to 4/5/09. LABS and Diagnostics: X-ray Abdomen - decreased gas in large bowel, distended small bowel. CBC - HGB 7.9 G/DL (L) HCT 24.6% (L) MCV 55.1 (L) MCH 55.1 PG (L) MCHC 30.0 G/DL (L) PLTS 698 TH/MM3 (H) Lymph 37.1% (H) Mono 13.5% (H) Neut 48.5% (L) Mono CT 1.20 TH/MM3 (H) RDW% (H) Neutrophils 44% (L) Lymphocytes 44% (H) PLT EST Increased. CHEM - Chloride 108 MMOL/L (H). Urine - Albumin 30 Ketones 15. Urine Culture - No Growth. Pathology Report - appendix.
CDC Split Type:

Write-up: 4 days after dose of Rota vaccine given patient developed intussuception requiring surgery for repair. 6/2/09 ER records received DOS 4/3/09. FINAL DIAGNOSIS: Acute Intussusception. Post vaccination vomiting, decreased po intake. Abdominal pain. Mild coryza. Blood in stool. Loose stools. Transfer to surgery. 6/10/09 Hospital records / DC summary received DOS 4/3/09 to 4/5/09. FINAL DIAGNOSIS: Insussusception. Post vaccination patient presented to ED - fussy, unwilling to take liquid by mouth, vomiting, bloody stool. Found to have intussusception irreducible by barium enema. Taken to OR for successful reduction of intussusception and appendectomy.


VAERS ID: 348296 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Tennessee  
Vaccinated:2009-05-13
Onset:2009-05-22
   Days after vaccination:9
Submitted: 2009-05-27
   Days after onset:5
Entered: 2009-06-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF612AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D18704 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0066Y / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium double contrast, Decreased appetite, Enema administration, Intussusception, Urinary system X-ray
SMQs:, Gastrointestinal obstruction (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: RANITIDINE 6/3/09 Hospital records received DOS 5/22/09. Reglan, Zantac.
Current Illness: None
Preexisting Conditions: Gastroesophageal Reflux Disease
Allergies:
Diagnostic Lab Data: KUB dose at office/air enema at medical center 6/3/09 Hospital records received DOS 5/22/09. LABS and DIAGNOSTICS: X-Ray of abdomen - possible obstruction. Ultrasound Abdomen Limited - intussusception.
CDC Split Type:

Write-up: Child developed poor appetite with associated vomiting, sudden in onset, worsening over a few hours. Child evaluated at office exam consistent with intussusception. Referred to medical center - air enema cured and diagnosed. 6/3/09 Hospital records received DOS 5/22/09. FINAL DIAGNOSIS: Intussusception Post vaccination not feeding well, fussy, projectile vomiting. Abdominal distension. Air enema reduction sucessful. 6/22/09 ICD-9 codes received. 560.0, 789.09


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