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This is VAERS ID 275361

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

Case Details

VAERS ID: 275361 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Unknown  
Vaccinated:2007-01-30
Onset:2007-03-23
   Days after vaccination:52
Submitted: 2007-03-30
   Days after onset:7
Entered: 2007-04-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER AC14B040CA / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0407F / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0456 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670K / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 1 UN / -

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal rigidity, Agitation, Barium double contrast, Haematochezia
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ischaemic colitis (broad)

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, 1 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hospitalization x 2 for RSV 12/06 & 1/07. several episodes of apnea. GERD. premature at 35 wks via c-section. Mother had problems w/prior pregnancies & required steroid injections for spontaneous prior abortions. ALLERGY to
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 19.5. US + for IS. Barium air contrast enema.
CDC Split Type:

Write-up: Information has been received from a physician concerning a 6 month old female who on 24-NOV-2006 was vaccinated with her first dose of Rotateq (LOT # not provided). On 30-JAN-2007, she was vaccinated with her second dose of Rotateq (LOT # not provided)."On 23-MAR-2007, the patient developed intussusception and was hospitalized. An air contrast enema was performed. Subsequently, the patient recovered from intussusception. The patient sought unspecified medical attention. There was no product quality compl


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