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This is VAERS ID 277899

Case Details

VAERS ID: 277899 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Unknown  
Vaccinated:2007-03-29
Onset:2007-04-23
   Days after vaccination:25
Submitted: 2007-05-03
   Days after onset:10
Entered: 2007-05-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C21521AA / 1 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0757F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0306 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 1 UN / -

Administered by: Other       Purchased by: Other
Symptoms: Barium double contrast, Intussusception
SMQs:, Gastrointestinal obstruction (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Barium enema X-ray
CDC Split Type: WAES0704USA05624

Write-up: Information has been received from a physician concerning a 11 week female who on 29-MAR-2007 was vaccinated with the first dose of Rotateq (Lot # 656189/1239F). Concomitant vaccinations included Dtap, PREVNAR, Comvax, poliovirus vaccine. On 23-APR-2007, the patient experienced intussusception and was hospitalized and given an air contrast enema. The patient recovered from intussusception on 25-APR-2007. Additional information has been requested. 5/15/07 Received vax record which confirmed RO Lot & dose as reported. VAERS database updated w/additional vax info from same date. 5/22/07 Received hospital medical records which reveal patient experienced irritability, bilious vomiting & bloody stool x 1 day. Seen in ER on 4/23 & dx w/IS by barium enema which also reduced successfully. Kept for overnight observation s/p reduction & progressed well. D/C home 4/24/07. Returned to ER on 4/27/07 for irritability/crying w/BM. Abdominal x-ray revealed nonspecific bowel gas pattern. US of abd was WNL & pt was d/c to home.


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