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This is VAERS ID 288141

Case Details

VAERS ID: 288141 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-08-14
Entered: 2007-08-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0708USA00165

Write-up: Information has been received from a physician concerning a patient who was vaccinated with a third dose of Rotateq. Subsequently, 4 weeks after the third dose, the patient developed intussusception. It was noted that the patient''s chart was not at the office so no further data was available at the time of the report. Upon internal review, the patient''s intussusception was considered to be an other important medical event. Additional information has been requested.


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