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This is VAERS ID 286408

Case Details

VAERS ID: 286408 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Unknown  
Vaccinated:2007-05-11
Onset:2007-07-25
   Days after vaccination:75
Submitted: 2007-07-31
   Days after onset:6
Entered: 2007-08-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC Split Type: WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


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