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This is VAERS ID 277569

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

Case Details

VAERS ID: 277569 (history)  
Form: Version .0  
Gender: Unknown  
Location: Unknown  
Submitted: 2007-04-27
   Days after onset:3
Entered: 2007-04-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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

Life Threatening? Yes
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: WAES0704USA05547

Write-up: Information has been received from a physician concerning a patient (age and sex not reported) who on an unspecified date was vaccinated with Rotateq (unknown how many doses of the vaccine the patient received). On 24-APR-2007, the patient experienced intussusception and was admitted to the hospital. The patient had surgery to remedy the situation. The reporter felt that intussusception was not related to therapy with Rotateq. Intussusception was considered to be immediately life-threatening and other important medical event. No further information was available from physician.

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