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This is VAERS ID 297890

Case Details

VAERS ID: 297890 (history)  
Form: Version 1.0  
Age: 0.39  
Gender: Female  
Location: South Carolina  
Vaccinated:2007-09-21
Onset:2007-10-29
   Days after vaccination:38
Submitted: 2007-11-26
   Days after onset:28
Entered: 2007-11-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0007U / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF204AC / 2 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0273 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0973U / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/28/07-records received-Air contrast enema consisten with intussusception to level of rectal vault. Abdominal ultrasound consistent with intussusception of lower rectum.
CDC Split Type: WAES0711USA03460

Write-up: Information has been received from a physician concerning a 2 year old female who on 21-SEP-2007 was vaccinated with a first (date unknown) and second (21-SEP-2007; 2 mL po) doses of Rotateq. On 29-OCT-2007, the patient experienced intussusception and melioration. Subsequently, the patient did not experience an adverse event with the first dose. The patient was hospitalized and had surgery. No further information was provided. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested. 11/28/07-operative report and lab reports received for DOS 10/29/10/31/07- Operative report:exploratory laparotomy, reduction of intussusception. Ladd procedure with appendectomy. on 10/29/07 3:00 a.m. emesis followed at 9:00 a.m. with bloody stool and became progressively lethargic. During reduction found patient was malrotated that the entire right colon was not fixed, that there were Ladd''s bands which crossed the duodenum which gave a very narrow mesenteric width. Could not completely mobilize the duodenum. 11/28/07-vac record received VAERS updated. 12/04/07-DC note received for DOS 10/27-10/31/07-DX Intussusception. Presented on 10/27/07 with acute onset of vomiting and bloody stools during night. No fever. Listless. Refusing oral intake.


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