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This is VAERS ID 270003

(NOTE: This result is from the 4/13/2011 version of the VAERS database)

Case Details

VAERS ID: 270003 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Texas  
Vaccinated:2006-09-26
Onset:2006-11-18
   Days after vaccination:53
Submitted: 2006-12-21
   Days after onset:33
Entered: 2007-01-03
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Hypophagia, Intussusception, Irritability, Ultrasound abdomen abnormal, Ultrasound kidney normal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Hypertension (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC Split Type: WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=270003


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