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This is VAERS ID 290658

(NOTE: This result is from the 6/14/2014 version of the VAERS database)

Case Details

VAERS ID: 290658 (history)  
Form: Version .0  
Age: 0.5  
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 / 2 - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal, Diarrhoea haemorrhagic, Enema administration, Explorative laparotomy, Intestinal ischaemia, Intestinal resection, Intussusception, Lethargy, Pyrexia, Surgery, Ultrasound scan normal, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Noninfectious diarrhoea (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:
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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