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This is VAERS ID 292698

Case Details

VAERS ID: 292698 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: North Dakota  
Vaccinated:2007-08-02
Onset:2007-09-13
   Days after vaccination:42
Submitted: 2007-10-10
   Days after onset:27
Entered: 2007-10-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133BA / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0066U / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510E / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0507U / 1 MO / PO

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? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: abdominal x-ray WNL. BE diagnosed & reduced IS.
CDC Split Type: WAES0710USA00520

Write-up: Information has been received from a nurse concerning a female who was vaccinated PO with a dose of Rotateq. Subsequently the patient experienced intussusception. The patient was seen in the physician''s office. The patient''s outcome was unknown at the time of this report. There was no product quality complaint. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 12/14/07 Received vax record from pcp. VAERS database updated w/same. 12/28/07 Reviewed hospital medical records which were only x-ray reports & reveal patient experienced diarrhea x 5 days, reduced oral intake & bloody stools. BE successfully reduced ileocolic intussusception. FINAL DX: ileocolic intussusception, enema reduced. 1/4/08 Reviewed hospital medical records which reveal patient experienced ileocolic IS 9/13 & was reduced by BE. Also had congestion & runny nose at that time. Returned to clinic 9/14 due to reduced oral intake. Assessment at that time was resolved IS & irritated stomach & was placed on clears. Returned to clinic 9/18 with continued reduced oral intake & cough. Exam at that time revealed dull TMs & tx w/antibiotics. Returned to ER 10/14 with diarrhea x 7 days & reduced oral intake. Abdominal x-ray at that time was WNL. Dx w/diarrhea possibly due to recent formula change.


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