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This is VAERS ID 294388

Case Details

VAERS ID: 294388 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Nebraska  
Vaccinated:2007-07-25
Onset:2007-10-04
   Days after vaccination:71
Submitted: 2007-10-24
   Days after onset:20
Entered: 2007-10-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2657AA / 3 UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z1069 / 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845H / 3 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal X-ray, 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: AXID
Current Illness: Gastrooesophageal reflux; Medical diet
Preexisting Conditions: PMH: viral infection w/fever 1 week prior to admit & rash 3 days prior to admit. Otitis media 2 weeks prior to admit. GERD.
Allergies:
Diagnostic Lab Data: diagnostic laboratory; abdominal X-ray; barium enema X-ray LABS: CBC WNL. Chemistry revealed dehydration. Abdominal x-ray revealed SBO. UGI WNL. Barium enema revealed mid-transverse colon IS & reduced.
CDC Split Type: WAES0710USA03475

Write-up: Information has been received from a physician concerning an 8 month old male with reflux and history of "MSPI type" diet with no other medical history or drug allergies who on 22-MAR-2007, 24-MAY-2007 and 25-JUL-2007 was vaccinated PO with his first, second and third doses (lot# 656381/0875U) of Rotateq. Concomitant vaccinations administered on 25-JUL-2007 included a dose of DTaP, a dose of poliovirus vaccine inactivated (unspecified) and a dose of (Prevnar). Other concomitant drug therapy included nizatidine (AXID) drops for reflux. On 04-OCT-2007 the patient experienced intussusception and was hospitalized. Medical attention was sought through the physician. Labs and abdominal x-rays were performed. A barium enema was also performed to reduce the intussusception. Subsequently, the patient recovered. There was no product quality complaint. Additional information has been requested. 10/26/07 Patient demographics provided by CDC. 10/30/07 Reviewed vax records which confirms RO dose & lot as reported & provides other vax info. VAERS database updated w/same. 11/2/07 Received hospital medical records which reveal patient experienced bilious vomiting x 2 days & 1 episode of bloody stool. Seen by pcp, sent to ER when vomiting persisted. Admitted 10/4-10/5/2007. Noted to have exanthem, lethargy, reduced oral intake & urine output. Progressed well s/p enema reduction & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


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