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This is VAERS ID 290658

Case Details

VAERS ID: 290658 (history)  
Form: Version 1.0  
Age: 0.51  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-08-27
Onset:2007-09-04
   Days after vaccination:8
Submitted: 2007-09-14
   Days after onset:10
Entered: 2007-09-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 3 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 3 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown ER LABS: abdominal sonogram WNL. Abdominal x-ray (+) for IS. CXR WNL.
CDC Split Type: WAES0709USA00598

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-2007 was sent to a hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available. 9/18/007 Received patient demographics from CDC. 9/18/07 Received ER medical records which reveal patient experienced abdominal pain, vomiting, bloody diarrahea, lethargy w/palpable mass in left mid abdomen. Had additional bloody diarrhea in ER. Transferred to higher level of care. ER Dx: Intussusception. 9/27/07 Linked w/291340. 10/19/07 Reviewed vaccination record from pcp. VAERS database updated w/same. Records faxed to CDC. 11/2/07 Received hospital medical records which reveal patient experienced bloody stools & fever. Admitted 9/5-9/12/2007. IS not reducible by BE in ER & was taken to surgery for laparoscopic reduction & exp laparotomy. Ileocecectomy performed to remove ischemic segment of cecum. ID consult done. Did well postoperatively & d/c to home FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


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