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This is VAERS ID 299161

Case Details

VAERS ID: 299161 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Ohio  
Vaccinated:2007-10-25
Onset:2007-11-24
   Days after vaccination:30
Submitted: 2007-12-03
   Days after onset:9
Entered: 2007-12-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF215AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0125 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Enema administration, Intestinal resection, Intussusception, Surgery
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cough, recent otitis
Preexisting Conditions: reactive airway disease. PMH: recent otitis media. NKDA.
Allergies:
Diagnostic Lab Data: Labs and diagnostics: Abd US (+) for IS. Air enema x2. Surgical pathology shows hemorrhagic necrosis, lymphoid hyperplasia and bacterial colonization.
CDC Split Type:

Write-up: Intussusception. Reoccurred after initial enema. Required operative repair with bowel resection. First Rotateq vaccine given at 13 wks of age on 8/21/07. 12/11/2007 Vax record received and corresponds to data on VAERS submission. 12/26/2007 MR received for DOS 11/26-30/2007 with D/C DX: Intussusception (ileocolic). Infant presented to ER with 24 hr hx of nausea, vomiting and abdominal pain. Pt had currant jelly/bloody BM. Air contrast enema reduction initially successful but recurred. 2nd attempt only partially successful after 3 attempts. Taken to OR for Exploratory Lap with attempted reduction of intussuscpeption; ileal and R colon resection with anastomosis. D/C on POD3#.


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