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This is VAERS ID 292564

Case Details

VAERS ID: 292564 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Georgia  
Vaccinated:2007-04-06
Onset:2007-10-03
   Days after vaccination:180
Submitted: 2007-10-04
   Days after onset:1
Entered: 2007-10-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0403F / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, PMH of intussusception in 6/2007.
Allergies:
Diagnostic Lab Data: Reduced by radiology by contrast enema. Labs and Diagnostics: CXR/Abd X-ray shows a paucity of gas in the rectum. Ultrasound demonstated intussusception to the level of the mid potion of the transverse colon. Therapeutic enema given with successful reduction. Labs and Diagnostics: Barium enema.
CDC Split Type:

Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.


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