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This is VAERS ID 282748

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

Case Details

VAERS ID: 282748 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Tennessee  
Vaccinated:2007-04-13
Onset:2007-06-01
   Days after vaccination:49
Submitted: 2007-06-22
   Days after onset:21
Entered: 2007-06-25
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 2 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8692A / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Irritability, Rectal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Allergies:
Diagnostic Lab Data: Unknown KUB suspicion of intussception vx. volvulus.
CDC Split Type: WAES0706USA01919

Write-up: Information has been received from a physician concerning a male infant who was vaccinated with a first and second oral dose of Rotateq (Lot# 655483/1116F and 656191/1365F) on 13-FEB-2007 and 13-APR-2007, respectively. Concomitant vaccine included a dose of Comvax and a dose of Dtap. On 01-JUN-2007 the patient developed intussusception. The patient was hospitalized where an air contrast enema was performed which resolved the problem. The number of days of hospitalization was not provided. No product quality complaint was involved. No other information was provided. Additional information has been requested. 7/11/07-ER note received for DOS-06/01/2007-DC DX: Intussception. C/O abdominal pain with history of not acting like himself. NG tube placed KUB suspicion of intussception vx. volvulus. Abrupt onset. 2-3 weeks prior fussy after his nightime feeds only. One BM today, blood found in rectum. Air contrast enema was completed and intussception was diagnosed. 8/15/07-DC Summary received-DC DX: Intussusception, status post reduction barium enema.


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