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This is VAERS ID 269503

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

Case Details

VAERS ID: 269503 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Arizona  
Vaccinated:2006-12-08
Onset:2006-12-20
   Days after vaccination:12
Submitted: 2006-12-21
   Days after onset:1
Entered: 2006-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Y1031 / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES 806681F / 1 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Intussusception, Lethargy, Ultrasound abdomen abnormal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: vomiting
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema
CDC Split Type:

Write-up: Patient had Rotateq on 9/29/06 and 12/8/06 and was diagnosed with intussusception on 12/20/06. Patient''''s symptoms were vomiting and lethargy. It was reduced with a barium enema. She is undergoing a UGI with small bowel follow through today to rule out"malrotation.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=269503


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