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This is VAERS ID 285151

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 285151 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Unknown  
Vaccinated:2007-03-20
Onset:2007-05-21
   Days after vaccination:62
Submitted: 2007-07-18
   Days after onset:58
Entered: 2007-07-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124F / 1 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 LL / -
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08670D / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Appendicectomy, Enema administration, Intussusception, Lethargy, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/12/07-records received-Contrast enema revealed presence of intussusception which could not be reduced hypostatically. Pneumatic reduction also unsuccessful.
CDC Split Type: WAES0707USA01897

Write-up: Information has been received from a physician''s assistant concerning a patient who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. Surgery was required. The patient recovered. No additional information was available. Intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/12/07-records received for DOS 5/23-5/29/07- DC DX: Intussusception. Open reduction with decompressive enterotomy and appendectomy. Presented with 2 day history of vomiting and alternating lethargy and crying. Post operative ileus


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