National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 288524

Case Details

VAERS ID: 288524 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Georgia  
Vaccinated:2007-06-28
Onset:2007-08-04
   Days after vaccination:37
Submitted: 2007-08-20
   Days after onset:16
Entered: 2007-08-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690F / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC Split Type: WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=288524


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166