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This is VAERS ID 273704

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

Case Details

VAERS ID: 273704 (history)  
Form: Version .0  
Age: 0.6  
Gender: Female  
Location: Alabama  
Vaccinated:2006-10-25
Onset:2006-11-17
   Days after vaccination:23
Submitted: 2007-03-08
   Days after onset:111
Entered: 2007-03-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1017F / 2 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Candidiasis, Gastrointestinal necrosis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 19,27. Blood c/s neg. Barium enema & air contrast enema were unsuccessful.
CDC Split Type:

Write-up: Information has been received from a physician concerning an 8 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 28-JUL-2006 (Lot # 654504/0695F), 28-AUG-2006 (Lot # 654504/0695F), and 25-OCT-2006 (65"4665/1017F). the patient had no medical history, no known drug allergies and was not on any concomitant medication. On 17-NOV-2006 the patient was seen in the doctors office and was diagnosed with intussusception. The patient was admitted to hospital that


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=273704


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