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This is VAERS ID 293275

Case Details

VAERS ID: 293275 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: New Mexico  
Vaccinated:2007-09-12
Onset:2007-09-27
   Days after vaccination:15
Submitted: 2007-10-15
   Days after onset:18
Entered: 2007-10-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B11UAB / 2 LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0078U / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B265108 / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0770U / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC Split Type: WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.


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