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This is VAERS ID 277111

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

Case Details

VAERS ID: 277111 (history)  
Form: Version 1.0  
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 / 3 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 3 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. B47742A / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1234F / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Wrong drug administered
SMQs:, Gastrointestinal obstruction (narrow), Medication errors (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, ? 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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