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This is VAERS ID 294997

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

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 / -
RV5: 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.


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