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This is VAERS ID 274607

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

Case Details

VAERS ID: 274607 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Unknown  
Vaccinated:2007-02-06
Onset:2007-03-09
   Days after vaccination:31
Submitted: 2007-03-22
   Days after onset:12
Entered: 2007-03-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal mass, Barium double contrast, Dehydration, Gastrointestinal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Labs in ER: WBC 12, Hgb 12, segs 67, lymphs 25 LABS: On admit to 2nd hospital: WBC 12.2, Hgb 12.2, plts 459. Abdominal x-ray c/w SBO. US of abdomen revealed +IS. Air contrast enema x 2 failed to reduce. Post op WBC 17.7, Hgb 10.3
CDC Split Type:

Write-up: Information has been received from a physician concerning a 3 month old patient who was vaccinated with the first dose of Rotateq. Subsequently, the patient experienced intussusception and was hospitalized. Intussusception was considered to be immediately"life-threatening and an other important medical event. The outcome was not reported. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=274607


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