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This is VAERS ID 290179

Case Details

VAERS ID: 290179 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Unknown  
   Days after vaccination:66
Submitted: 2007-09-07
   Days after onset:34
Entered: 2007-09-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None Family HX: patient''s sister & aunt also had IS.
Diagnostic Lab Data: Unknown LABS: multiple KUBs. Abdominal x-ray. Air enema unsuccessful.
CDC Split Type: WAES0708USA05423

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who on 30-MAY-2007 was vaccinated with a dose of Rotateq (Lot# 656385/0030U). On 04-AUG-2007 the patient had surgery for intussusception and was hospitalized. Subsequently, the patient recovered. No product quality complaint was involved. No other information was provided. The patient''s experience was considered to be immediately life-threatening, disabling, and an other important medical event by the reporter. Additional information has been requested. 9/28/07 Received hospital medical records which reveal patient experienced vomiting, irritability, restlessness, abdominal distention & bloody stools x 2 days. Seen in outlying ER & transferred to higher level of care. Admitted 8/4-8/7/2007. IS was nonreducible by air contrast enema & taken to OR for exp lap w/reduction of IS & open appendectomy. Progressed well but continued to have bloody stools throughout hospitalization but lessened w/more formed stools. D/C to home w/pcp & surgical f/u. FINAL DX: Intussusception, surgically reduced.

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