This is VAERS ID 291810
| Days after vaccination:||8
| Days after onset:||19
| Days after submission:||1
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS
||AC21B124AA / 2
||LL / -
|HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.
||1273F / 2
||RL / -
|PNC: PNEUMO (PREVNAR) / PFIZER/WYETH
||B9728313 / 2
||RL / -
|RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.
||0972U / 2
||MO / PO
Administered by: Public Purchased by: Other
SMQs:, Gastrointestinal obstruction (narrow)
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC Split Type: WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
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