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This is VAERS ID 290934

Case Details

VAERS ID: 290934 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Unknown  
Vaccinated:2007-06-11
Onset:2007-07-07
   Days after vaccination:26
Submitted: 2007-09-19
   Days after onset:74
Entered: 2007-09-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0777F / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 9/20/07-records received-X-ray and US no obstruction. Stool guaiac positive.
CDC Split Type: WAES0709USA02272

Write-up: Information has been received from a physician concerning a 7-month-old male who on 11-JUN-2007 was vaccinated with a third dose of Rotateq. Concomitant therapy included Prevnar, PedvaxHIB, IPOL and Daptacel. On 07-JUL-2007 the patient went to the emergency room in a hospital and had surgeries for intussusception and appendectomy (not further specified). It is unknown how long the patient was hospitalized. On an unspecified date, the patient recovered and was discharged. No product quality complaint was involved. The reporter considered intussusception to be an other important medical event and life threatening. Additional information has been requested. 9/20/07-records received with report-presented to ED 7/19/07 with 2 day C/O fever, vomiting, no stool. Surgical repair of Intussusception.


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