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This is VAERS ID 273010

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 273010 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Mississippi  
Vaccinated:2006-12-29
Onset:2007-02-23
   Days after vaccination:56
Submitted: 2007-02-26
   Days after onset:3
Entered: 2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Barium enema, Diarrhoea, Haematochezia, Intussusception, Lethargy, Pyrexia, X-ray abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Ischaemic colitis (broad)

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC Split Type:

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


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