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This is VAERS ID 275896

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 275896 (history)  
Form: Version .0  
Age: 0.5  
Gender: Female  
Location: Unknown  
Vaccinated:2007-01-09
Onset:2007-02-12
   Days after vaccination:34
Submitted: 2007-04-09
   Days after onset:55
Entered: 2007-04-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Bacteria stool identified, Barium enema, Blood urine present, C-reactive protein increased, Diarrhoea, Eyelid ptosis, Gastroenteritis, Haematochezia, Intestinal obstruction, Intussusception, Ketonuria, Lethargy, Occult blood positive, Oral intake reduced, Pyrexia, Rotavirus test negative, Small intestinal intussusception reduction, Surgery, Urine analysis, Vomiting, Weight decreased, White blood cell count increased, White blood cells urine positive
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (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, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC Split Type: WAES0703USA05645

Write-up: Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rotateq (Lot #''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN-2007 the patient experienced diarrhea and vomiting and was hospitalized. The initial diagnosis was acute gastroenteritis. The patient''s symptoms worsened, and the third day of hospitalization, the patient had blood in her stool and was diagnosed with bowel intussusception. The patient underwent surgical repair on 14-FEB-2007. The patient was discharged from the hospital within 24 hours of surgery, and was noted to be recovered. The patient was seeing another practice at the time of the report. No additional information is expected. There was no product quality complaint. The physician indicated that the intussusception was not related to vaccination with Rotateq. Additional information has been requested. 04/20/2007 Records received from PCP which include vax record and D/C summary from 1st hospitalization and D/C order form and Final Report from transfer facility. Infant presented to PCP on 02/12/2007 with a 2 day hx. of diarrhea, vomiting, lethargy and not eating well. 2 lb weight loss. Assessment: Acute gastroenteritis and dehydration. Admitted to hospital for IV hydration and further management. Transfered to another facility on 2/13/07 for eval. by a pediatric surgeon for possible intestinal obstruction vs. intussusception. Barium enema was obtained on 2/14/07 which was (+) for intussusception which could only be partially reduced. Pt went for laparoscopic reduction of the intussusception on 2/14/07. Discharged the next day. D/C DX: Incarcerated Intussusception.


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