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This is VAERS ID 309001

Case Details

VAERS ID: 309001 (history)  
Form: Version 1.0  
Age: 0.38  
Sex: Female  
Location: Pennsylvania  
   Days after vaccination:44
Submitted: 2008-04-04
   Days after onset:196
Entered: 2008-04-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Crying, Diarrhoea, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: barium enema X-ray 09/21/07 - intussusception resolved 8/4/08-records received- US confirmed intussusception in right upper quadrant. Therapeutic contrast enema, successful reduction of ileocolic intussusception.
CDC Split Type: WAES0803USA04735

Write-up: Information has been received from a physician concerning a 26 week old female who on 25-MAY-2007 and 08-AUG-2007 was vaccinated PO with her first and second 2.0 ml doses of Rotateq (lot# "12337," 656393/0240U). On 21-SEP-2007 the patient was seen in the physician''s office since the patient experienced vomiting, crying and loose stools. The patient did not have bloody stools. The patient was admitted to a hospital that same day and was diagnosed with intussusception. The patient was hospitalized for 3 days. A barium enema resolved the intussusception. The patient was discharged from the hospital on 23-SEP-2007. On 24-SEP-2007 the patient was seen in the physician''s office and the physician stated the patient had been vomiting, but with no dehydration. The patient had a bowel movement with no blood in the stools. Therapy with Rotateq was discontinued on 08-AUG-2007. The physician stated the patient was recovering. There was no product quality complaint. Additional information has been requested.8/4/08-records received for DOS 9/21-9/23/07-DC DX: Intussusception. Presented to ED with C/O vomiting and loose bowel movement times 1-2 days. Crying, irritable.

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