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This is VAERS ID 303317

Case Details

VAERS ID: 303317 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: Unknown  
Vaccinated:2007-09-19
Onset:2008-01-09
   Days after vaccination:112
Submitted: 2008-01-15
   Days after onset:6
Entered: 2008-01-23
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0769U / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown 3/14/08-records received-PMH: respiratory syncytial virus.
Allergies:
Diagnostic Lab Data: Unknown 3/14/08-records received-CT scan showed ileocolic intussusception and an attempt to reduce with barium enema which was unsuccessful. RSV and rotavirus negative. Labs WNL except for Glucose of 121.
CDC Split Type: WAES0801USA02370

Write-up: Information has been received from a nurse concerning an 8 month old female who on 06-JUN-2007 was vaccinated with the first dose of Rotateq (Lot # 656393/0240U). On 19-SEP-2007, the patient was vaccinated with the second dose of Rotateq (Lot # 657522/0769U). On 09-JAN-2008 the patient came into the office lethargic and spitting up. The patient was sent to a local hospital and was transferred to another hospital where she was admitted. The patient had surgery on 09-JAN-2008 for intussusception. As of 10-JAN-2008, the patient was "stabilized". The nurse felt that the intussusception was life-threatening and an other important medical event. A lot check has been requested. Additional information has been requested. 3/14/08-records received for DOS 1/9-1/11/08-DC DX: Intussusception. Hx of 1 bloody stool, vomiting and lethargy. Refused to eat. Exploratory laparotomy with reduction of intussusception and appendectomy.


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