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This is VAERS ID 279891

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 279891 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Texas  
Vaccinated:2007-03-02
Onset:2007-04-26
   Days after vaccination:55
Submitted: 2007-05-25
   Days after onset:29
Entered: 2007-05-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR 2552AA / 1 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 80326 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258C / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal rigidity, Abdominal tenderness, Bacteria urine, Barium double contrast, Eyes sunken, Fluid intake reduced, Full blood count normal, Haematuria, Heart rate increased, Intussusception, Irritability, Ketonuria, Large intestinal obstruction reduction, Pallor, Red blood cells urine positive, Urinary system X-ray, Urine analysis abnormal, Vomiting, White blood cells urine positive
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CBC WNL. UA with 10 WBCs, 12 RBCs, 2+ bacteria, 3+ ketone, trace blood. KUB showed no obstruction, increased gas. Air Contrast enema showed intussusception-partially reduced. Repeat enema with (+) reductio
CDC Split Type: WAES0705USA02888

Write-up: Information has been received from a physician concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first, second, and third oral dose of Rotateq (Lot# "1116D," 656188/1238F, and 656194/0024U) on 17-JAN-2007, 02-MAR-2007, and 15-MAY-2007, respectively. There was no concomitant medication. On 26-APR-2007 the patient was treated at the emergency room for intussusception and then released. No other symptoms were noted. Subsequently, the patient recovered. No product quality complaint was involved. the patient''s intussusception was considered to be an other important medical event by the reporter. A lot check has been requested. Additional ifnormation has been requested. 06/11/2007 MR received from Elaine Miller CDC. Hospital record for ER admit on 4/25-27/2007 for c/o vomiting x6 which began the night prior. No stool noted that day. Also c/o fussiness and drinking less. PE: revealed an alert but mildly fussy infant with sunken eyes and dry mucus membranes. HR in the 140''s. Abdomen tender with guarding. pallor noted. Ped. surgery note 4/27 reveals infant tolerating po, voiding well, no blood noted in stools, abdomen soft and round. D/C to home. DX: Intussusception- Air enema reduced.


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