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This is VAERS ID 283990

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 283990 (history)  
Form: Version .0  
Age: 0.1  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-04-11
Onset:2007-06-12
   Days after vaccination:62
Submitted: 2007-07-05
   Days after onset:23
Entered: 2007-07-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal X-ray, Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection
SMQs:, Disorders of sinus node function (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Ischaemic colitis (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, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Information has been received from a physician concerning an approximately 4 month old female who was vaccinated with a second dose of Rotateq. On 12-JUN-2007 the patient developed intussusception and was hospitalized. It was reported that the patient had"to have a resection of the bowel. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''''s intussusception was considered to be immediately life-threatening and an other important me


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