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This is VAERS ID 308211

Case Details

VAERS ID: 308211 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:2007-08-28
Onset:2008-03-19
   Days after vaccination:204
Submitted: 2008-03-25
   Days after onset:6
Entered: 2008-03-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Intussusception, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
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:
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC Split Type: WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


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