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This is VAERS ID 294451

Case Details

VAERS ID: 294451 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Virginia  
Vaccinated:2007-09-12
Onset:2007-10-21
   Days after vaccination:39
Submitted: 2007-10-22
   Days after onset:1
Entered: 2007-10-25
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / UNK MO / PO

Administered by: Private       Purchased by: Private
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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC Split Type:

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.


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