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This is VAERS ID 286493

Case Details

VAERS ID: 286493 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Mississippi  
Vaccinated:2007-04-03
Onset:2007-06-01
   Days after vaccination:59
Submitted: 2007-08-01
   Days after onset:61
Entered: 2007-08-02
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 1 MO / PO

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

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown Birth HX: preterm 37.5 wks. jaundice.
Allergies:
Diagnostic Lab Data: Unknown LABS: CT of head in ER was WNL. KUB in ER revealed obstruction. Abdominal x-ray. UGI showed poor peristalsis. Water soluble BE revealed ileocolic IS, only partially reduced.
CDC Split Type: WAES0707USA03737

Write-up: Information has been received from a physician concerning an approximately 5 month old male who on 05-APR-2007 was vaccinated orally with a 2 ml dose of Rotateq (lot# 656192/0022U). Subsequently, the patient experienced intussusception, was hospitalized and released after surgery. On an unspecified ate, the patient recovered. No product quality complaint was involved. A lot check was requested. Intussusception was considered to be immediately life-threatening and an other important medical event. Additional information has been requested. 9/11/07 Reviewed pcp medical records & vax records which corrected vax lot #. VAERS database updated w/same. Records reveal patient experienced good health w/sneezing, pinpoint facial rash & colic. Hospitalized 6/1-6/6 for intestinal polyp surgery. Received 2nd dose RO on 6/21. 3rd dose held. 9/25/07 Reviewed hospital medical records which reveal patient experienced bilious emesis on day of admit 6/2-6/6/2007 followed by coffee grounds emesis & bloody stool. Seen at outside ER & transferred for higher level of care. Upon admit was lethargic, abdomen soft & nondistended & no mass palpable. To OR for exp laparotomy & reduction of ileocolonic IS. Did well post op & d/c to home when tolerating oral feeds & having stool. FINAL DX: Ileocolonic Intussusception, surgically reduced. 9/25/07 pcp medical records & vax record faxed to CDC.


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