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This is VAERS ID 284854

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

Case Details

VAERS ID: 284854 (history)  
Form: Version .0  
Age: 0.6  
Sex: Male  
Location: Unknown  
   Days after vaccination:85
Submitted: 2007-07-16
   Days after onset:54
Entered: 2007-07-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Computerised tomogram abnormal, Haematochezia, Inappropriate schedule of drug administration
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Information has been received from a physician concerning an 11 month old male who on 27-FEB-2007 was vaccinated with Rotateq PO /"the last dose/". The patient developed an intussusception and was hospitalized. Subsequently, the patient recovered from int"ussusception. Intussusception was considered to be disabling, life threatening and caused hospitalization. Additional information has been requested.

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