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This is VAERS ID 309000

Case Details

VAERS ID: 309000 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:2008-03-14
Onset:2008-03-20
   Days after vaccination:6
Submitted: 2008-04-04
   Days after onset:15
Entered: 2008-04-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Barium enema abnormal, Intussusception
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with obstruction. Hydrostatic reduction attempted, unable to reduce. WBC 18.3, % neutrophils 36, monocytes 10 and lymphocytes 52. Alkaline phos 263. Potassium 5.5. Stool for WBC negative.Stool culture negative.
CDC Split Type: WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


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