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This is VAERS ID 266161

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 266161 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: New Jersey  
Vaccinated:2006-10-02
Onset:2006-10-08
   Days after vaccination:6
Submitted: 2006-11-07
   Days after onset:30
Entered: 2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 0 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE965AA / 0 RL / -
PNC: PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08642E / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC Split Type:

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


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