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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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