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This is VAERS ID 297390

Case Details

VAERS ID: 297390 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Texas  
Vaccinated:2007-09-21
Onset:2007-10-31
   Days after vaccination:40
Submitted: 2007-11-19
   Days after onset:19
Entered: 2007-11-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B0976B / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08697C / 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02424 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 10/31?/07 12/10/07-records received-Contrast enema reduction unsuccessful. Stools positive for occult blood. US abnormal.
CDC Split Type: WAES0711USA02185

Write-up: Information has been received from a physician concerning a 7 month old male who on 15-MAY-2007 received a first oral 2 ml, and a second dose on 21-SEP-2007 of Rotateq. On 31-OCT-2007, he developed intussusception. It was reported he was seen in the physician''s office, was hospitalized, and underwent emergency surgical correction after he failed to respond to an enema. The patient was discharged and was to have a follow up visit on 09-NOV-2007 with his physician. No other symptoms or treatment was reported. A product quality complaint was not reported. No further information was available. The patient''s intussusception was determined to be an other important medical event, and life threatening by the reporter. Additional information has been requested. 12/10/07-records received-for DOS 10/31-11/03/07-DC DX: Idiopathic ileocolic intussusception. Presented with vomiting and bloody diarrhea times 1 day. Abdominal ultrasound showed instussusception. Exploratory laparotomy mandual reduction of intussusception and incidental appendectomy.


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