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This is VAERS ID 291938

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 291938 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Kansas  
   Days after vaccination:29
Submitted: 2007-10-02
   Days after onset:14
Entered: 2007-10-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown 11/6/07-records received-intussusception reduced by air enema.
CDC Split Type: WAES0709USA04474

Write-up: Information has been received from a physician concerning a male infant who at a 4 month old visit was vaccinated with his second dose of Rotateq and later experienced intussusception. Unspecified medical attention was sought. The patient''s recovery status was unknown. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 11/6/07-records received for DOS 9/19-9/20/07-intussusception reduced by air enema. History of bloody stools and emesis. Observed after procedure, tolerated breast feeding, discharged.

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