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This is VAERS ID 292243

Case Details

VAERS ID: 292243 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: New York  
Vaccinated:2007-07-24
Onset:2007-09-24
   Days after vaccination:62
Submitted: 2007-10-04
   Days after onset:10
Entered: 2007-10-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2570BA / 3 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 6223F / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE958AA / 3 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal X-ray, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: presumed viral gastroenteritis 2 wks prior.
Allergies:
Diagnostic Lab Data: abdominal X-ray 09/25/07- suspicious for intussusception LABS: guiac (+) stool. Abdominal c-ray neg. Abdominal US (+) IS to hepatic flexure/right transverse colon. Repeat US of abdomen on 9/26 revealed recurrent IS.
CDC Split Type: WAES0710USA00016

Write-up: Information has been received from a physician and nurse concerning an 18 month old male who was vaccinated PO with three doses of Rotateq (lot numbers not available). On 25-SEP-2007 the patient developed intussusception and was hospitalized for 2 days. An abdominal x-ray was performed in hospital and the results were suspicious for intussusception even though a diagnosis of intussusception was not made. Subsequently, the patient fully recovered and was discharged from the hospital on 26-SEP-2007. There was no product quality complaint. Additional information has been requested. 10/16/07 Received vax record from pcp. VAERS database updated w/same. Record faxed to CDC. 10/23/07 Reviewed hospital medical records which reveal patient experienced crying, colicky abdominal pain, malodorous stool & bright yellow vomiting x 1 day. Exam revealed diffuse abdominal tenderness. Peds surgery consult done. Tx w/contrast enema & reduced IS. Admitted 9/24-9/25/07 for observation s/p reduction. Progressed well & d/c to home. Returned to ER on 9/26 w/abdominal pain, bloody stool. Recurrent IS reduced w/barium enema. 3rd abd US s/p reduction was WNL. Admitted 9/26-9/27/07 for observation. Progressed well & D/C to home. FINAL DX: Intussusception, recurrent, reduced x 2 by enema. Records faxed to CDC.


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