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This is VAERS ID 309002

Case Details

VAERS ID: 309002 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Texas  
Vaccinated:2007-03-20
Onset:2007-04-07
   Days after vaccination:18
Submitted: 2008-04-04
   Days after onset:363
Entered: 2008-04-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UE973AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B34258F / 2 RA / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Gastrointestinal necrosis, Intestinal resection, Intussusception, Lethargy
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (narrow), Hypoglycaemia (broad)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 4/22/08-records received-Water soluble contrast gastrografin enema: intussusception initially located near the level of the proximal mid descending colon and which is reduced as far as the proximal mid ascending colon. However, persistent intussusception at level of proximal mid ascending colon is noted. CT brain unremarkable. CXR: normal. Blood, urine and CSF culture no growth. CRP increased 2.9. Neutrophil % increased 47, lymphocytes increased 4.9, sed rate increased 29.
CDC Split Type: WAES0803USA04729

Write-up: Information has been received from a physician concerning a 21 week old male who on an unknown date and on 20-MAR-2007 was vaccinated PO with his first and second 2.0 ml doses of Rotateq. On approximately 07-APR-2007 per the physician, "the patient was brought into the office at 5 months old and was lethargic." On 27-APR-2007 the patient diagnosed with intussusception and was hospitalized (amount of time unknown). Surgery was performed and the patient had a necrotic bowel therefore the bowel had to be resected. The patient returned to the office for a follow-up visit and the third dose of Rotateq was administered by a different provider in the office. Subsequently, the patient recovered. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 4/22/08-record received-Surgical report 4/29/07-Intussusception, ileocolic and ilioiliac due to mesenteric adenitis and possible hypertrophic tire patches, terminal ileum. Exploratory laparotomy with reduction of ileocolic anastomosis and small bowel resection. Seen in ER with 3 day history of URI like symptoms. Lethargic after receiving anti-histamine. Nausea and vomiting. Diminished appetite and urine output. Low grade temperature. Weight loss. Dehydration. Drowsiness secondary to possible antihistamine overdose.


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