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This is VAERS ID 316001

Case Details

VAERS ID: 316001 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Alabama  
Vaccinated:2008-06-04
Onset:2008-06-09
   Days after vaccination:5
Submitted: 2008-09-11
   Days after onset:94
Entered: 2008-06-11
   Days after submission:92
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0017X / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception, Ultrasound scan abnormal
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow)

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: None
Current Illness: Intussusception
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: U/S - Failed BE - required surgery. 8/7/08 records received-Laparscopic reduction of intussusception after multiple attempts to reduce using air barium contrast enema. Reduction incomplete and intussuception remained in ascending colon. Labs 6/10/08-segs elevated 58%, lymph % decreased at 27%, albumin decreased 2.9. US of abdomen demonstrated intussusception in right lower quadrant. Moderate amount of ascites. Abdominal x-ray distended loops of small bowel with numerous air-fluid levels,findings compatible with small bowel obstruction. multiple attempts to reduce using air barium contrast enema.
CDC Split Type:

Write-up: Intussusception 8/7/08-records received-6/10/08-emesis and bloody stool. Laparscopic reduction of intussusception 8/7/08-records received-6/10/08-emesis and bloody stool. Laparscopic reduction of intussusception after multiple attempts to reduce using air barium contrast enema. Reduction incomplete and intussuception remained in ascending colon.8/28/08-DC Summary received for DOS 6/10-6/11/08-DC DX: Intussusception. Presented to ED with C/O bilious emesis and bloody stools, yesterday began spitting up more, fussy and taking less formula, bloody stool this morning, refuses to take formula.


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