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This is VAERS ID 300086

Case Details

VAERS ID: 300086 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Texas  
Vaccinated:2007-08-14
Onset:2007-10-04
   Days after vaccination:51
Submitted: 2007-12-14
   Days after onset:71
Entered: 2007-12-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR AC14B099AA / 3 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0614 / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854007D / 3 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0138F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/26/07-records received- Barium enema demonstrated intussusception in the distal transverse colon. Trace protien and ketones in urine. Potassium elevated.
CDC Split Type: WAES0712USA02737

Write-up: Information has been received from a registered nurse concerning a 6 month old white male with no pre-existing allergies, birth defects, medical conditions, who on 14-AUG-2007 at 9:15 AM was vaccinated po with a third dose of Rotateq (lot number: 653661/0138F). The patient was hospitalized for intussusception. There were no relevant diagnostic tests and laboratory data. There was no illness at time of vaccination. There were no adverse events following prior vaccinations. The outcome was reported as recovered. There was no product quality complaint. Additional information has been requested. 12/26/07-records received for DOS 10/4-10/5/07- DC DX: Intussusception of large bowel, reduced. Viral gastroenteritis. Mild dehyrdation. Successfully reduced by barium enema. Presented to ED with nausea, projectile vomiting and stomach cramps. In ED one small bloody diarrheal stool.


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