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This is VAERS ID 279106

Case Details

VAERS ID: 279106 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Arizona  
Vaccinated:2007-02-27
Onset:2007-04-20
   Days after vaccination:52
Submitted: 2007-05-18
   Days after onset:28
Entered: 2007-05-21
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2521AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF068AB / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20240 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08678K / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 2 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: bilat OM approx 10 days prior to admit
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA02715

Write-up: Information has been received from a physician concerning a 6-month-old male who on 05-DEC-2006 and 27-FEB-2007 was vaccinated PO with the first and second doses of Rotateq (lot number not available). On 20-APR-2007, approximately 7 weeks after receiving the second dose, the patient experienced intussusception and was hospitalized. The patient had surgery to correct this and has subsequently recovered. There was no product quality complaint involved. The event was considered to be immediately life-threatening by the reporter. Additional information has been requested. 5/25/07 Received vax records from PCP but did not include vax lot numbers. T/C to PCP office to request info. 5/25/07 received vax records w/lot numbers. VAERS database updated w/same. 6/18/07 Received hospital medical records which reveal patient experienced vomiting x 4 days & crampy abdominal pain. Seen in ER where UGI revealed bowel obstruction. Admitted 4/20-4/24/07. Air contrast enema confirmed IS but could not reduce. Taken to OR for exp lap, small resection w/primary anastomosis & appendectomy. Progressed well & was d/c to home. FINAL DX: Small bowel-small bowel intussusception reduced by exp laparotomy, small bowel resection w/primary anastomosis & appendectomy.


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