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This is VAERS ID 295494

Case Details

VAERS ID: 295494 (history)  
Form: Version 1.0  
Age: 0.67  
Gender: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2007-10-04
Submitted: 2007-11-02
   Days after onset:29
Entered: 2007-11-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception
SMQs:, Gastrointestinal obstruction (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA05309

Write-up: Information has been received from a physician concerning an 8 month old male who received his third 2.0 ml oral dose of Rotateq. On 04-OCT-2007, the patient developed intussusception. The patient sought unspecified medical attention and has recovered. A product quality complaint was not reported. No further information was available. Upon internal review intussusception was determined to be an other important medical event. Additional information has been requested.


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