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This is VAERS ID 320829

Case Details

VAERS ID: 320829 (history)  
Form: Version 1.0  
Age: 0.42  
Sex: Male  
Location: Michigan  
Submitted: 2008-07-29
   Days after onset:28
Entered: 2008-07-30
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal distension, Haematochezia, Intussusception, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: x-ray, Reduced airflow and suspected intussusception
CDC Split Type: WAES0807USA04599

Write-up: Information has been received from a physician concerning a 5 month old male patient who was vaccinated with a dose of ROTATEQ on an unknown date. The physician, who works in the emergency room, reported that she was aware of a patient who presented to the emergency room with possible intussusception in JUL-2008. The patient''s symptoms were vomiting, abdominal distention, and blood in the stool. The emergency room performed an x-ray and determined that the patient had reduced airflow and suspected intussusception. This adverse event occurred one week after a dose of ROTATEQ. It is unknown if the adverse event occurred after the first, second, or third vaccination. The patient was sent to another hospital that specializes in pediatrics but it is unknown if the child was admitted. No product quality complaint was involved. Upon internal review, intussusception was considered to be another important medical event. Additional information has been requested.

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