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This is VAERS ID 277111

(NOTE: This result is from the 7/31/2010 version of the VAERS database)

Case Details

VAERS ID: 277111 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: California  
Vaccinated:2007-03-01
Onset:2007-03-19
   Days after vaccination:18
Submitted: 2007-04-19
   Days after onset:31
Entered: 2007-04-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER U1751BA / 2 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 2 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Wrong drug administered
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: eczema
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen revealed +intussussception. Air enema successfully reduced.
CDC Split Type: WAES0704USA02415

Write-up: Information has been received from a physician concerning a 6 month old male who on 01-MAR-2007 was vaccinated with a 2 mL PO third dose of Rotateq. Concomitant vaccination included a dose of pneumococcal, polyval (MSD), a dose of HIB and a dose of DTaP. On 19-MAR-2007 the patient developed intussusception and was hospitalized. Surgery was not required. Subsequently, the patient recovered from intussusception on 3/21/07. There was no product quality complaint involved. Additional information has been requested. 5/4/07 Received medical records from hospital which reveal patient seen in ER on 3/20-3/21/07 for vomiting, abdominal pain, inconsolable fussiness, lethargy & dark heme + diarrhea stools. Kept overnight for observation. Did well, tolerated oral feedings & was d/c to home w/o complication. FINAL DX: Intussusception, reduced by air enema. 5/29/07 Received vax record which confirmed RO as reported. VAERS database updated w/other vax info.


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