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This is VAERS ID 278389

Case Details

VAERS ID: 278389 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: Arkansas  
Vaccinated:2007-04-13
Onset:2007-05-01
   Days after vaccination:18
Submitted: 2007-05-11
   Days after onset:10
Entered: 2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8691 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC Split Type:

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


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