This is VAERS ID 303591

Case Details

VAERS ID:	303591 (history)
Form:	Version 1.0
Age:	0.5
Gender:	Female
Location:	Iowa

Vaccinated:	2007-10-24
Onset:	2008-01-13
Days after vaccination:	81
Submitted:	2008-01-25
Days after onset:	12
Entered:	2008-01-25

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B124CA / 3	LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0676U / 3	RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08700K / 3	RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1391U / 3	MO / PO

Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan
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, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC Split Type:

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.

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