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This is VAERS ID 292129

Case Details

VAERS ID: 292129 (history)  
Form: Version 1.0  
Age: 0.49  
Gender: Male  
Location: Missouri  
Vaccinated:2007-05-23
Onset:2007-09-04
   Days after vaccination:104
Submitted: 2007-10-03
   Days after onset:29
Entered: 2007-10-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B113AA / 4 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8679F / 4 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00030U / 4 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow), Medication errors (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: BE revealed IS. CT of abdomen revealed bowel obstruction or severe ileus.
CDC Split Type: WAES0710USA00021

Write-up: Information has been received from a physician concerning a 10 month old patient (gender not reported) who on an unspecified date was vaccinated with the completed 3 dose series of Rotateq. Subsequently the patient experienced intussusception and was hospitalized. The intussusception was corrected surgically. On an unspecified date, the patient recovered from intussusception. Intussusception was considered to be immediately life-threatening. Additional information has been requested. 10/8/07 Patient demographics provided by CDC. 10/26/07 Received vax record & VAERS database updated w/same. Also received tag 2 report from pcp which included AE onset. Record faxed to CDC. 11/27/07 Reviewed hospital medical records which reveal patient experienced blood in stools, fever & vomiting x 2 days. Seen by pcp who dx w/gastroenteritis & sent home. Vomiting continued & taken to ER. Admitted 9/5-9/18/2007. He appeared dehydrated & ill. BE done revealed colocolic IS but not able to reduce. Taken to OR where exp laparotomy with right extended hemicolectomy w/primary anastomosis & re-exploration laparoscopically with open reduction of IS was done. Did well initially post operatively but on day 3-4 became distended & vomited. Continued for several days & unable to tolerate oral feeds. Taken back to OR where second IS was found & easily reduced. Progressed well after 2nd surgery & d/c to home. FINAL DX: Intussusception, recurrent, surgically reduced x 2 with hemicolectomy. Records faxed to CDC.


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