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This is VAERS ID 291299

Case Details

VAERS ID: 291299 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: California  
Vaccinated:2007-04-25
Onset:2007-06-12
   Days after vaccination:48
Submitted: 2007-09-21
   Days after onset:101
Entered: 2007-09-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0071U / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666E / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 2 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Abdominal X-ray, Barium enema, Chest X-ray, Intussusception, Surgery, Urinary system X-ray, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/13/07 KUB, cross table (lateral) of abdomen, chest x-ray; 6/13/07 Barium enema. Labs and Diagnostics: Barium enema x2 (+) for IS. KUB (+) for Ileus.
CDC Split Type:

Write-up: Patient received Rotavirus vaccine on 2/23/2007 and 4/25/07. Patient seen at clinic 6/12/07 with vomiting on and off for 6 hrs. Patient admitted to hospital 6/12/07. Pt diagnosed with intussusception and had corrective surgery 6/13/2007. Pt discharged 6/15/2007. 10/02/2007 Vax record received and data corresponds with what was reported on VAERS form./pc 10/26/2007 D/C Summary received for hospital DOS 6/12-15/2007 for DX Ileoileal and Ileocolic Intussusception. Infant presented with bilious emesis and blood per rectum. Barium enema performed which demonstrated IS to the cecum from mid transverse colon but was unsuccessful in reduction. Repeat BE only partially successful at reduction. Infant then had a Laparoscopic Reduction of Intussusception and Appendectomy. Post-operatively the pt developed an marked ileus which resolved on POD #2 when the pt began tolerating po and had a non-bloody BM.


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