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This is VAERS ID 271991

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 271991 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: Illinois  
   Days after vaccination:43
Submitted: 2007-02-08
   Days after onset:13
Entered: 2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery
SMQs:, Anaphylactic reaction (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Diagnostic Lab Data: NONE LABS: all WNL.
CDC Split Type:

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of R"otateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed wit

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