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This is VAERS ID 283990

(NOTE: This result is from the 3/2/2010 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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1275F / 0 LL / IM
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B086B4H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal X-ray, Intestinal ischaemia, Intussusception, Sinus bradycardia, Small intestinal resection, Surgery, Volvulus, Vomiting, Waist circumference increased, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Disorders of sinus node function (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Lipodystrophy (broad)

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. Labs and Diagnostics: Abd X-ray (+) for filling defect in RLQ with distended bowel loops. WBC 21.
CDC Split Type: WAES0706USA04746

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 medical event by the reporter. Additional information has been requested. 09/17/2007 D/C Summary received from CDC for DOS 6/12-20/2007 for DX of Volvulus. Infant presented with 1 day hx of increasing abdominal girth and vomiting. Pt taken to OR for an irreducible intussusception and had a short segment of volvulus with ischemic bowel. Pt had a small bowel resection with an ileum to R colon primary anastomosis. Cardiology consult for sinus bradycardia determined to be a normal variant. Pt resumed feeds and was D/C home.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100302&IDNUMBER=283990


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