National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 301249

Case Details

VAERS ID: 301249 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Arizona  
Vaccinated:2007-10-25
Onset:2007-11-22
   Days after vaccination:28
Submitted: 2007-12-28
   Days after onset:36
Entered: 2007-12-31
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2749AA / 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1278F / 1 LL / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0111 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35A4 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 1 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:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Chemistry WNL. Abd X-ray suspicious for IS. Abd US with IS identified in the R and proximal transverse colon. Enema administration
CDC Split Type: WAES0712USA08462

Write-up: Information has been received from a nurse concerning an approximately 13 week old male who on 25-OCT-2007 was vaccinated PO with his first dose of Rotateq (lot# 656379/0505U). Concomitant vaccinations administered on that same day included a dose of DTaP, a dose of PedvaxHIB, a dose of Prevnar. On approximately 22-NOV-2007 the patient experienced intussusception, was hospitalized and underwent surgery on 22-NOV-2007 (length of stay and type of surgery not specified). Subsequently, the patient recovered. It was noted that the patient discontinued the series for the second and third doses of Rotateq. There was no product quality complaint. Intussusception was considered to be an other important medical event (surgery) by the reporter. Additional information has been requested. 01/10/2008 Vax info updated in database. 02/12/2008 MR received for DOS 11/22-23/2007 with D/C DX: Intussusception. Infant presented with vomiting, bloody, brownish stools, refusal to eat and screaming. Several day hx of nasal congestion. Pt underwent reduction of IS via enema in ER. Admitted for observation post procedure and D/Cd next day.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=301249


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166