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This is VAERS ID 282652

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 282652 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Louisiana  
Vaccinated:2007-01-08
Onset:2007-03-10
   Days after vaccination:61
Submitted: 2007-06-21
   Days after onset:102
Entered: 2007-06-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08620K / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: 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, 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.


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