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This is VAERS ID 274364

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 274364 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Female  
Location: North Carolina  
Vaccinated:2006-12-29
Onset:2007-03-03
   Days after vaccination:64
Submitted: 2007-03-19
   Days after onset:15
Entered: 2007-03-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK records received 4/17/07-Labs: WBC 45.9, platelets 613, 53% granulocytes. Flu test negative. Urine culture negative. Stool for occult blood positive. Rotavirus stool negative. Enema positive for mid transverse colon intussusception, unable to completely reduce with enema. Histology:peripheral blood smear, normocytic anemia. thrombocytosis.
CDC Split Type: WAES0703USA01240

Write-up: Information has been received from a physician concerning a 6 month old Middle Eastern female who was vaccinated with a first and second dose of Rotavirus on 27-OCT-2006 and 29-DEC-2006, respectively. On 03-MAR-2007 the patient was hospitalized for intussusception, which required surgery, but no bowel resection. Subsequently, the patient recovered. No other information was provided. Additional information has been requested. 04/17/07-records received from facility for DOS 3/2-3/5/07 DC DX: Intussusception. Fever. Leukocytosis. 6 day HX of vomiting, has had no stool no diarrhea. Prior to admission fever 103.5. Weight down 14 ounces. Congestion with clear runny nose. Afebrile upon admission. 2nd day of admission passed mucusy stool with streaks of blood. PE: WNL, abdomen soft and nontender. Surgery reduction ileocecal intussusception and appendectomy


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