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This is VAERS ID 285685

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

Case Details

VAERS ID: 285685 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: Unknown  
Vaccinated:2007-05-01
Onset:2007-05-28
   Days after vaccination:27
Submitted: 2007-07-23
   Days after onset:56
Entered: 2007-07-24
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC Split Type: WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


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