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This is VAERS ID 285152

Case Details

VAERS ID: 285152 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: California  
Vaccinated:2007-05-30
Onset:2007-07-03
   Days after vaccination:34
Submitted: 2007-07-18
   Days after onset:15
Entered: 2007-07-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B07AA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 784F / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086665 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC Split Type: WAES0707USA02148

Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy


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