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This is VAERS ID 293964

Case Details

VAERS ID: 293964 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Florida  
Vaccinated:2007-08-29
Onset:2007-09-06
   Days after vaccination:8
Submitted: 2007-10-19
   Days after onset:43
Entered: 2007-10-22
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF120AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679K / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0169U / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Crying, Intussusception, Pain
SMQs:, Gastrointestinal obstruction (narrow), Depression (excl suicide and self injury) (broad)

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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA02633

Write-up: Information has been received from a physician concerning an 8 week old male who received his first dose of oral Rotateq. On an unspecified date, he was seen in the physician''s office after he had developed sudden bouts of crying and appeared to be in pain. At the time of this report, the physician was awaiting the results of unspecified test but he suspects a diagnosis of intussusception. It is reported that the patient has not recovered. A product quality complaint was not reported. No further information was available. Upon internal review it was determined that intussusception was an other important medical event. Additional information has been requested. 10/23/07 Patient demographics provided by CDC./ss 10/23/2007 Reviewed hospital medical records which reveal patient experienced emesis x 2, diarrhea, irritability, decreased oral intake x 1 week. Seen by pcp & KUB obtained c/w IS. Confirmed by BE as outpatient & sent to outlying hospital but they were unable to do the BE for reduction. Transferred to higher level of care. Repeat KUB revealed distended bowel but no IS. Admitted 9/7-9/8/07 for observation s/p reduction. Had recurrent IS s/s. US of abdomen confirmed IS within transverse colon recurred & air contrast enema successfully reduced. Surgical consult done. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/30/07 Reviewed hospital ER records which reveal patient seen 9/6/07 with intermittent emesis, watery stools & poor appetite x 4 days. BE revealed IS & patient transferred to higher level of care. Records faxed to CDC.


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