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This is VAERS ID 268479

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 268479 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Wisconsin  
Vaccinated:2006-09-05
Onset:2006-11-06
   Days after vaccination:62
Submitted: 2006-12-04
   Days after onset:28
Entered: 2006-12-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Haematochezia, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC Split Type: WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


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