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This is VAERS ID 314720

Case Details

VAERS ID: 314720 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New York  
Vaccinated:2008-03-26
Onset:2008-05-19
   Days after vaccination:54
Submitted: 2008-05-29
   Days after onset:10
Entered: 2008-06-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0474 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1840U / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Hemoglobin 8.6, hematocrit 25.5, lymphocytes 32, absolute neutrophils 9.19. blood urea nitrogen 2, creatinine <0.2. Ultrasound diagnosis of intussusception with unsuccessful attempt to reduce with Gastrografin enema. Post op abdominal pain with repeat ultrasound negative.
CDC Split Type:

Write-up: Child developed intussusception 7 1/2 weeks after receiving second dose of ROTATEQ. 6/18/08-records received for DOS 5/19-5/24/08- DC DX: Colocolic intussusception. One day history of lethargy and irritability. Diet refusal, non-bilious emesis and mucus bloody stool. Exploratory laparotomy and reduction. Post op abdominal pain with repeat ultrasound negative. Foley catheter placement.


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