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This is VAERS ID 288995

Case Details

VAERS ID: 288995 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Texas  
Vaccinated:2007-05-01
Onset:2007-05-14
   Days after vaccination:13
Submitted: 2007-08-25
   Days after onset:103
Entered: 2007-08-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium double contrast, Enema administration, Intussusception, X-ray
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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC Split Type:

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


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