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This is VAERS ID 262993

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

VAERS ID: 262993 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Texas  
Vaccinated:2006-08-04
Onset:2006-09-05
   Days after vaccination:32
Submitted: 2006-09-13
   Days after onset:8
Entered: 2006-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (UNKNOWN MFR) / UNKNOWN MANUFACTURER 03897 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0192R / 1 RL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. UE812AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Y1051 / 1 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08655E / 1 RA / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. - / - - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Constipation, Haematochezia, Intussusception, Irritability, Laboratory test abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad)

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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI and congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Open reduction with diagnosis of by CT scan Labs: On admission WBC 16,000, hematocrit 35, essentially normal electrolytes. US did not show evidence of intussusception and Upper GI was anatomically normal. CT on 9/6/06: significant for ileo
CDC Split Type:

Write-up: Rotateq given 5/23/06 and 8/4/06 developed intussusception Sept 5th requiring surgical reduction. 99/19/06-received office note for DOS 8/1-9/5/06- note for 9/5/06-vomiting/possible dehydration. vomiting times 2 days, constipated 2 days ago, blood in diap"er today, small amount of stool. PE: awake alert responsive, unsmiling. Abdomen soft non-tender, transfer to hospital. Operative Report received from Southwest Texas Methodist Hospital: 9/7/06-Pre operative DX: Intussusception Postoperative DX and DC DX/:


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