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This is VAERS ID 286563

Case Details

VAERS ID: 286563 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-05-29
Onset:2007-07-11
   Days after vaccination:43
Submitted: 2007-08-02
   Days after onset:22
Entered: 2007-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 00710 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679C / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Enema administration, 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, 4 days
   Extended hospital stay? No
Previous Vaccinations: intussception~Rotavirus (Rotateq)~2~0.40~In Patient
Other Medications:
Current Illness: No
Preexisting Conditions: None PMH: eczema.
Allergies:
Diagnostic Lab Data: Air enema documenting intussusception Hospital LABS: WBC 18.3, neutros 65, lymphs 29. Chemistry WNL. Blood & urine c/s neg. CXR WNL. Abdominal x-ray revealed IS. Air enema revealed ileocolic intussusception, unable to reduce. Post op KUB was WNL.
CDC Split Type:

Write-up: Patient Received Rotavirus vaccine (along with DTaP, Hep B, IPV, HiB, Prevnar) on 5/29/07. On 7/11/07, she presented to the ED and was diagnosed with intussusception. Did not resolve with air enema. Required surgical reduction. 8/21/07 Received hospital medical records which reveal patient experienced nausea, vomiting & bloody stools x 1 day. Admitted 7/11-7/15/07. X-ray revealed IS & air enema failed to reduce. Taken to OR for exp laparotomy. Patient did well post op & d/c to home. FINAL DX: Intussusception, s/p surgical reduction. 8/21/07 Received clinic records including vax records which confirm RO dose & lot as reported. Patient w/runny nose & cough on day of vax. RTC 6/5 w/fever, runny nose, cough. Dx: viral syndrome. 7/23 f/u visit post op for vomiting, cranky, cough, fever. DX: viral syndrome & possible UTI.


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