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This is VAERS ID 273704

(NOTE: This result is from the 5/14/2017 version of the VAERS database)

Case Details

VAERS ID: 273704 (history)  
Form: Version .0  
Age: 0.61  
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
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1017F / 2 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow), Medication errors (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: WAES0703USA00508

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 (654665/1017F). 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 same day, where she underwent emergency surgery. On 22-NOV-2006, the patient was discharged from the hospital. on 07-DEC-2007, the patient was seen in the doctors office for a well-visit and was considered recovered from the intussusception. There was no product quality complaint involved. Additional information has been requested. 3/22/07 Received medical records from hospital which reveal patient experienced intermittent abdominal pain associated w/vomiting approx 24 hours prior to admit on 11/17/06-11/22/06. Seen by PCP who noted bloody stool & tender abdomen. Barium enema performed at outlying facility but failed to reduce IS noted in mid transverse colon near splenic flexure. Then transferred to higher level of care where air reduction enema was also unsuccessful. Peds Surg consult obtained. Taken to OR where ileocolic resection w/primary anastomosis was performed. Progressed slowly but steadily, oral diet tolerated by d/c to home w/o further complication except for oral thrush which was treated. FINAL DX: Ileocecal intussusception w/necrotic bowel, surgically reduced w/bowel resection.


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