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This is VAERS ID 277165

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 277165 (history)  
Form: Version .0  
Gender: Unknown  
Location: California  
Submitted: 2007-04-20
Entered: 2007-04-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA02490

Write-up: Information has been received from a physician concerning three patients who were vaccinated with Rotateq 2.5 ml PO to prevent Rotateq. The physician reported that all three patients experienced intussusception and were hospitalized. The length of hospitalization was unknown. The three patients requires surgery to correct the intussusception but the outcome of the surgery and the type of surgery is unknown. Intussusception which required surgery was reported to be an other important medical event. Additional ifnormation has been requested.

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