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This is VAERS ID 299144

Case Details

VAERS ID: 299144 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: South Carolina  
Vaccinated:2007-03-30
Onset:2007-04-11
   Days after vaccination:12
Submitted: 2007-12-07
   Days after onset:240
Entered: 2007-12-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684K / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None 12/20/07-records received-PMH: GERD.
Allergies:
Diagnostic Lab Data: Unknown 12/20/07-records received-WBC 24.7. Air enema inconclusive for intussusception with refluxing into the small bowel. there was an initial obstruction of the air column at hepatic fleuxure.
CDC Split Type: WAES0711USA05712

Write-up: Information has been received from a physician concerning a 21-week-old female with no medical history who on 16-JAN-2007 (lot #655174/0848F) and 30-MAR-2007 (lot #656187/1237F) was vaccinated PO with the first and second 2.0 mL doses, respectively, of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). They physician reported that on 11-APR-2007, the patient developed intussusception. The physician noted that there was no adverse event involved after the patient was vaccinated with the first dose. At the time of this report, the outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested.12/20/07-records received for DOS 4/11-4/14/07-DC DX: Intussusception. Reduced by Barium contrast enema. Acute episode of vomiting, nonbloody nonbilious, approximately 20 episodes of emesis and an episode of abdominal pain. Lethargic, tachycardic with poor peripheral perfusion. Following enema patient passed a current jelly stool in ED.


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