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This is VAERS ID 266155

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 266155 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: North Dakota  
Vaccinated:2006-10-13
Onset:2006-10-18
   Days after vaccination:5
Submitted: 2006-11-03
   Days after onset:16
Entered: 2006-11-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 1 UN / -

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Crying, Intussusception, Muscle spasms, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (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? 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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound 10/18/2006 intussusception.
CDC Split Type: WAES0610USA13121

Write-up: Information has been received from a physician concerning a 11 week old female who on 10/13/06 was vaccinated with the first 2.0ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine) (lot 654504/0695F). The physician reported that on 10/18/06, the pt developed severe vomiting. The pt was vomiting so much that she was hospitalized where an ultra sound was performed and a diagnosis of intussusception was made. On the evening of 10/18/06, the intussusception was reduced by Barium enema. It was noted that the pt experienced cramping, crying and whining until midnight. On 10/19/2006, the pt was discharged from the hospital as her intussusception was considered to be resolved. The physician also considered the intussusception to be life threatening. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=266155


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