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This is VAERS ID 274607

(NOTE: This result is from the 1/4/2011 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:2007-03-10
   Days after vaccination:32
Submitted: 2007-03-22
   Days after onset:11
Entered: 2007-03-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2552AA / 0 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV319AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE990AA / 0 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646D / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1116F / 0 UN / -

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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 Birth Hx: normal FT birth & pregnancy per ER record.
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: WAES0703USA03407

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. 4/6/07 Received medical records from both hospitals today which reveal: Hospital #1 ER - seen 3/10/07 for blood in stool night before & that AM. Also vomited that AM. Was seen by PCP on 3/9 & thought to be possible allergy, tx w/benadryl. After second bloody stool, went to ER. Dx w/acute GI bleed. Tx w/IVF & transferred to higher level of care. Hospital #2 Admission 3/10/07-3/13/07. Received into PICU & surg consult obtained. Exam revealed patient to be lethargic & mildly dehydrated despite prior IVFs. Abdomen was soft, nondistended w/+BS but also with a palpable mass along the left side of the abdomen, LLQ. Rectal exam revealed mucosal mass almost protruding from rectum. Air contrast enema x2 failed to reduce. Patient taken to OR for exp lap, reduction of right colon-ileocecal IS w/difficulty due to edematous & ischemic cecum & appendectomy. Patient progressed well & was able to tolerate oral diet prior to d/c on 3/13/07. FINAL DX: Ileocecal intussusception, surgically reduced.


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