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This is VAERS ID 271991

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 271991 (history)  
Form: Version .0  
Age: 0.52  
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: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Diagnostic Lab Data: NONE LABS: all WNL.
CDC Split Type: WAES0701USA05034

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 Rotateq 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 with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.

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