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This is VAERS ID 285684

(NOTE: This result is from the 5/13/2011 version of the VAERS database)

Case Details

VAERS ID: 285684 (history)  
Form: Version .0  
Age: 0.5  
Gender: Female  
Location: Unknown  
Vaccinated:2007-05-30
Onset:2007-06-28
   Days after vaccination:29
Submitted: 2007-07-23
   Days after onset:25
Entered: 2007-07-24
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF08711 / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination records received 8/20/07- sodium 160 chloride 124, neutrophils 32.1 mono 23.2. protein in urine 30. Rotavirus negative. Findings of fluoro exam consistent with ileocolic intussusception. Unable to reduce. Abdominal series x-ray possible distal small bowel obstruction.
CDC Split Type: WAES0707USA02147

Write-up: Information has been received from a physician concerning a 7 month old female who was vaccinated with third 2 ml oral dose of Rotateq. Concomitant vaccinations given at the same time included DTaP, Hib and IPV. Subsequently, the patient experienced intussusception and was hospitalized (length of stay unspecified). A physical examination was performed results not provided. Intussusception was considered to be immediately life-threatening and an other important medical event which required surgery. Additional information has been requested. 8/20/07-records received from facility for DOS 7/1-7/2/07- DX: Intussusception. Incisional Reduction of intussusception lysis of fiber strands, appendectomy. C/O 4 days vomiting and diarrhea with some blood yesterday,


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