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This is VAERS ID 286279

Case Details

VAERS ID: 286279 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2007-01-03
Onset:2007-06-05
   Days after vaccination:153
Submitted: 2007-07-26
   Days after onset:51
Entered: 2007-07-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1508670R / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Barium enema, Enema administration, Intussusception, Surgery, X-ray
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the rectum.
CDC Split Type: WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


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