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This is VAERS ID 308065

Case Details

VAERS ID: 308065 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:2008-03-04
Onset:2008-03-10
   Days after vaccination:6
Submitted: 2008-03-20
   Days after onset:10
Entered: 2008-03-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC Split Type:

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


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