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This is VAERS ID 269503

(NOTE: This result is from the 3/2/2010 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) / SANOFI PASTEUR C2521AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 806681F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Dehydration, Enema administration, Intussusception, Lethargy, Ultrasound abdomen abnormal, Vomiting, X-ray gastrointestinal tract normal
SMQs:, Acute pancreatitis (broad), 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), 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? 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 LABS: US of abd revealed intussusception. BE successfully reduced. UGI w/ small bowel f/t showed normal anatomy.
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. 2/5/07 Received medical records from hospital which reveal patient experienced vomiting & lethargy for 5 days & was admitted to hospital 12/20/06-12/21/06. Exam revealed patient was dehydrated. IS was suspected, successfully reduced & patient was admitted for overnight observation s/p reduction due to possibility of malrotation or mobile cecum. Ped surgery consult done FINAL DX: Intussusception, reduced by BE.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100302&IDNUMBER=269503


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