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This is VAERS ID 286278

Case Details

VAERS ID: 286278 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Male  
Location: Unknown  
Vaccinated:2007-05-31
Onset:2007-07-09
   Days after vaccination:39
Submitted: 2007-07-26
   Days after onset:17
Entered: 2007-07-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow)

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, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis.
CDC Split Type: WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


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