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This is VAERS ID 299144

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 299144 (history)  
Form: Version .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 / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08684K / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Haematochezia, Intussusception, Lethargy
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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, 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:

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 ro"tavirus 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 fi


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