This is VAERS ID 275635

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

Case Details

VAERS ID:	275635 (history)
Form:	Version 1.0
Age:	0.3
Gender:	Female
Location:	Maryland

Vaccinated:	2007-01-23
Onset:	2007-02-11
Days after vaccination:	19
Submitted:	2007-04-05
Days after onset:	52
Entered:	2007-04-05

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR	U1813AB / 2	- / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER	Z0306 / 2	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0940F / 2	MO / PO

Administered by: Private Purchased by: Public
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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC Split Type:

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.

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