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This is VAERS ID 274366

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

Case Details

VAERS ID: 274366 (history)  
Form: Version 1.0  
Age: 0.42  
Gender: Female  
Location: New York  
Vaccinated:2007-01-17
Onset:2007-03-07
   Days after vaccination:49
Submitted: 2007-03-19
   Days after onset:11
Entered: 2007-03-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 1110F / UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Constipation, Diarrhoea, Gastroenteritis rotavirus, Haematochezia, Intussusception, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK records received 4/12/07-Labs SEgs 80.7. lymphs 15.6. Blood culture no growth. Abdominal x-ray highly suspicious for intussusception
CDC Split Type: WAES0703USA01485

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), respectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was reported that, according to the hospital discharge summary, 24 hours prior to presentation at the hospital, on 07-MAR-2007, the patient began with nausea, vomiting, abdominal pain and constipation. The patient was admitted to the hospital on 08-MAR-2007 and had episodes of vomiting, diarrhea, and bloody stools. The patient was diagnosed with ileocolic intussusception, which was initially encountered in the distal transverse colon. It was also noted by the physician on the discharge summary that the patient had rotavirus. The patient did not have surgery and the intussusception was reduced by an air contrast enema. The patient was discharged on 10-MAR-2007 and had recovered. The patient''s intussusception and rotavirus were considered to be other important medical events by the reporter. A lot check has been requested. Additional information has been requested. 04/12/07-records received from facility for DOS 03/08-03/10/2007. DC DX: Ileocolic intussusception. Diagnosed and treated with air contrast enema. Developed abdominal pain 24 hours prior to presentation with decreased PO intake, several episode of vomiting and an episode of diarrhea but no further bowel movements over 24 hours. Febrile to 38.3. PE bowel sounds present soft non distended tender to palpation no masses palpable. Rectal grossly bloody stool in rectal vault.


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