This is VAERS ID 282652

Administered by: Other       Purchased by: Other
Symptoms: Abdominal X-ray, Blood culture negative, Computerised tomogram abnormal, Constipation, Enema administration, Gastroenteritis, Intussusception, Melaena, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC Split Type: WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.