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This is VAERS ID 315516

Case Details

VAERS ID: 315516 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Florida  
Vaccinated:2007-09-28
Onset:2008-01-08
   Days after vaccination:102
Submitted: 2008-06-06
   Days after onset:149
Entered: 2008-06-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 3 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0066U / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007H / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0877U / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None. PMH: RAD
Allergies:
Diagnostic Lab Data: None. Labs and Diagnostics: Barium Enema (+) for IS. Abd X-ray 1/19/08 WNL. CBC and Chem unremarkable.
CDC Split Type: WAES0806USA00031

Write-up: Information has been received from a physician assistant (PA) concerning an approximately 6 to 7 month old patient with no medical history or allergies who on unspecified dates was vaccinated po with all three doses of ROTATEQ. There was no concomitant medication. The PA reported the patient experienced intussusception and was hospitalized (no time frame was available). The patient''s outcome was not reported. Additional information has been requested. 6/16/2008 MR received for 2 ER visits 1/8/08 and 1/19/2008 with DX: Intussusception. 2nd visit for not eating well s/p IS. infant presented with 12 hr hx of vomiting as well as crying as if in pain. Taking nothing po. IS noted on Barium enema but uncuccessful at reducing. Transfered to higher level of care. 7/10/2008 MR received for DOS 1/9-11/2008 with D/C Dx Intussusception s/p reduction and appendectomy. Infant received for transfer s/p unsuccessful BE reduction. Pt taken to OR for laparotomy and reduction with appendectomy and lymph node biopsy. Did well post-op and d/c home


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