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This is VAERS ID 308061

Case Details

VAERS ID: 308061 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:2007-08-23
Onset:2008-01-13
   Days after vaccination:143
Submitted: 2008-01-22
   Days after onset:9
Entered: 2008-03-25
   Days after submission:62
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Enema administration, 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: dermatitis
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Air contrast barium enema able to reduce IS.
CDC Split Type:

Write-up: Pt was hospitalized at hospital for treatment of intussusception treated with an contrast enema. Received ROTATEQ 6/16/07, 8/23/07. 04/09/2008 MR received for DOS 1/13-14/2008 with D/C DX: Intussusception. Pt presented to ER with acute onset of bilious vomiting and abdominal discomfort. PE (+) for abdominal tenderness and RLQ emptiness. Air contrast barium enema able to reduce IS. Normal BMs by HD#3. PCP f/U 1/17/08 with report of normal stool.


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