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This is VAERS ID 273760

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

Case Details

VAERS ID: 273760 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Tennessee  
Vaccinated:2007-02-14
Onset:2007-03-08
   Days after vaccination:22
Submitted: 2007-03-09
   Days after onset:1
Entered: 2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abnormal faeces, Barium double contrast, Bowel sounds abnormal, Dehydration
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound con
CDC Split Type:

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day hi"story of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended


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