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This is VAERS ID 298456

Case Details

VAERS ID: 298456 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: California  
Vaccinated:2007-11-09
Onset:2007-11-20
   Days after vaccination:11
Submitted: 2007-11-30
   Days after onset:10
Entered: 2007-12-03
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0255U / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abnormal faeces, Barium enema, Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad)

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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: antimicrobial (unspecified)
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray 11/??/07 4/15/08 Received additional lab reports from CDC: appendix revealed extensive ulcerated mucosa w/necrosis & fibromucopurulent debris in lumen, mixed inflammatory cell infiltrates & hemorrhage. Testing for adenovirus & rotavirus were neg.
CDC Split Type: WAES0711USA04977

Write-up: Information has been received from a physician concerning a 4 month old female who on approximately 06-NOV-2007 was vaccinated PO with the second 2.0 ml dose of Rotateq (no lot number provided). Concomitant drug therapy included "antimicrobial (unspecified)." On 20-NOV-2007 two and a half weeks after being vaccinated, the patient experienced intussusception characterized by an abnormal stool and was hospitalized for a total of 3 days. A barium enema test was performed and the patient underwent surgery to repair the intussusception." On 23-NOV-2007 the patient was released from the hospital. Subsequently, the patient recovered. There was no product quality complaint. The physician also considered intussusception to be an other important medical event (surgery). Additional information has been requested. 1/11/08 Reviewed hospital medical records which reveal patient experienced irritability, black stools & bilious emesis x 12 hours which progressed to bloody stools. Went to outlying ER where gastrograffin enema reveals IS that could not be reduced despite 3 attemps. Transferred to higher level of care for surgical management. Admitted 11/20-11/23/2007. On admit, lethargic, distended abdomen w/epigastric mass palpablel. To OR for exp lap, no bowel resection needed. Did well post op & d/c to home. Final DX: intussusception, surgically reduced. 1/22/08 Reviewed vax record.


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