VAERS ID: |
294997 (history) |
Form: |
Version .0 |
Age: |
0.3 |
Gender: |
Male |
Location: |
Kentucky |
Vaccinated: | 2007-10-05 |
Onset: | 2007-10-07 |
Days after vaccination: | 2 |
Submitted: |
2007-10-30 |
Days after onset: | 23 |
Entered: |
2007-10-31 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0079U / 1 |
LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B53981A / 1 |
LL / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0669U / 1 |
- / PO |
Administered by: Other Purchased by: Other Symptoms: Abdominal X-ray,
Appendicectomy,
Blood gases abnormal,
Enema administration,
Explorative laparotomy,
Haematochezia,
Intussusception,
Nausea,
Vomiting,
White blood cell count increased SMQs:, Acute pancreatitis (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)
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, 2 days
Extended hospital stay? Yes
Previous Vaccinations: Other Medications: Unknown Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O de Preexisting Conditions: Unknown Allergies: Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified. CDC Split Type: WAES0710USA04368
Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on the same day. The patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day. |