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This is VAERS ID 285684

(NOTE: This result is from the 5/13/2013 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
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal X-ray, Blood sodium increased, Diarrhoea, Diarrhoea haemorrhagic, Intussusception, Neutrophil count increased, Protein urine present, Rotavirus test negative, Surgery, Vomiting
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Chronic kidney disease (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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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=285684


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