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This is VAERS ID 286714

Case Details

VAERS ID: 286714 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Georgia  
Vaccinated:2007-04-26
Onset:2007-07-04
   Days after vaccination:69
Submitted: 2007-07-31
   Days after onset:27
Entered: 2007-08-03
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 2 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1415F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692A / 2 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Computerised tomogram abnormal, Intussusception, Surgery
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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Cystic Fibrosis Birth Hx: no problems but was screened for cystic fibrosis at birth. (+) cystic fibrosis gene. PMH: 1/07 dx w/cystic fibrosis, mild.
Allergies:
Diagnostic Lab Data: CT ABO, BE, Abdominal surgery LABS: X-ray c/w intussusception. Air enema reveled IS.
CDC Split Type:

Write-up: This is just for statistical information. This baby developed intussusception 7/4/07 at 6 months of age. He had two doses of Rotateq at 2 and 4 months of age (with other shots). He had not received the third dose. 8/10/07 Received pcp medical records including vax records which confirm RO dose & lot # as reported. Records reveal patient experienced good development & was healthy on day of vax. Seen in ER on 7/4 s/p vomiting & bloody stools. CT confirmed IS. BE could not reduce & had surgery. Returned to office on 7/30 for post op check & doing well. 8/24/07 Received hospital medical records which reveal patient experienced nonbilious emesis, abdominal pain & distention, low grade fever & jelly like stool x 2 days. Admitted 7/5-7/6/07. Air enema x 3 unable to reduce IS. Taken to OR for laproscopic reduction of IS. Progressed well & d/c to home. FINAL DX: Ileocolic intussusception, surgically reduced.


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