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This is VAERS ID 285492

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 285492 (history)  
Form: Version .0  
Age: 0.6  
Gender: Female  
Location: Texas  
Vaccinated:2007-03-15
Onset:2007-06-10
   Days after vaccination:87
Submitted: 2007-07-20
   Days after onset:40
Entered: 2007-07-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 62283AA / 5 RA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 2 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Explorative laparotomy, Intussusception, Rectal haemorrhage, Tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Air contrast Barium Enema (+) for Intussusception
CDC Split Type: WAES0707USA01506

Write-up: Information has been received from a office manager in a physician''s office concerning a 10 month old female, with no allergies, no history of surgery, no prior history of intussusception, congenital malformation of the intestine, or cystic fibrosis, who was vaccinated with a first, second, and third dose of ROTATEQ on 18-JAN-2007 (Lot# 653980/0285F), 15-FEB-2007 (Lot# 654489/0941F), and 15-MAR-2007 (Lot# 655405/1113F), respectively. It was reported that the office received an operative report stating that the patient was admitted to the hospital on 10-JUN-2007 after a visit to the emergency room. She had an exploratory lapartomy with reduction of intussusception and appendectomy on 10-JUN-2007. The diagnosis was unreducable intussusception. It was noted that the patient''s family had not reported any signs or symptoms prior to the emergency room visit. The patient had not been back to the office for a follow-up. No other information was provided. Additional information has been requested. 09/10/2007 Discharge Summary received for DOS 6/10-13/2007 for Dx of Intussusception. Infant presented with hx of vomiting and one episode of blood per rectum. On PE slightly tachycardic otherwise unremarkable. Air contrast barium enema revealed Intussusception, unable to be fully reduced. Taken to OR for Exploratory Lap with reduction of the Intussusception and appendectomy.


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