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This is VAERS ID 269030

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

Case Details

VAERS ID: 269030 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Wisconsin  
Vaccinated:2006-10-18
Onset:2006-12-11
   Days after vaccination:54
Submitted: 2006-12-14
   Days after onset:3
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0500F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Z0420 / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08691A / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0849F / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Intestinal obstruction, Intussusception, Laboratory test abnormal, Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: PMH previously healthy infant with hx. of hyperbilirubinemia after birth which required phototherapy.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics remarkable for a WBC of 17.5 with 78 segs, 0 bands. KUB showed dilated bowel loops and no free air. Contrast enemas did not show any signs of intussusception. Upper GI with small bowel follow-through showed no malr
CDC Split Type:

Write-up: Small Bowel Obstruction possibly intussusception 12/11/2006 (approximately 7 week after Rotateq). Report came in with MR attached documenting an almost 4 month old''''s admission for bilious vomiting and lethargy. PMH previously healthy infant with hx. of h"yperbilirubinemia after birth which required phototherapy. Mother noticed infant to be more irritable than usual but with no other symptoms initially. The following day she noticed yellowish-green emesis and continued vomiting as well as lethargy. 911 wa


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=269030


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