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This is VAERS ID 292397

Case Details

VAERS ID: 292397 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Florida  
Vaccinated:2007-09-20
Onset:2007-10-08
   Days after vaccination:18
Submitted: 2007-10-08
   Days after onset:0
Entered: 2007-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Barium enema, Intussusception
SMQs:, Gastrointestinal obstruction (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, 1 days
   Extended hospital stay? No
Previous Vaccinations: Diarrhea~Vaccine not specified (no brand name)~3~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reduced with Barium enema 10/25/07-records received- Ultrasound abdomen ileocolic intussusception.Barium enema reduction of intussusception. Blood culture no growth.
CDC Split Type:

Write-up: PO Rotavirus vaccination on 9/20/07 in doctor''s office. Admitted to hospital 10/8/07 with diagnosis of intussusception. 10/25/07-records received DOS 10/8/07-DX: Intussusception. 12 days prior to admission developed low grade fever and 3 episodes of vomiting. Treated with Pedialyte and no emesis for 1 week. Last week had dark brown stools, has not had a bowel movement since 4 days prior to admission. 3 days prior to admission cranky, more fussy, intermittently crying, drawing legs up or became rigid. Vomiting began day prior to admission.


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