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This is VAERS ID 321007

Case Details

VAERS ID: 321007 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Tennessee  
Vaccinated:2008-06-23
Onset:0000-00-00
Submitted: 2008-07-31
Entered: 2008-08-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF260AB / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A480 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35173 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211XDT / 2 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: therapy unspecified; PREVACID; REGLAN
Current Illness:
Preexisting Conditions: Gastrooesophageal reflux
Allergies:
Diagnostic Lab Data: Unknown LABS: US of abdomen (+). Gastrografin enema. Neutros 75%(H), lymphs 21%(L), monos 3%(L). CO2 21(L), creatinine 0.27(L). Blood c/s neg.
CDC Split Type: WAES0807USA05332

Write-up: Information has been received from a physician concerning a 5 month old patient with a history of gastrooesophageal reflux who was vaccinated with the second dose of ROTATEQ, 1 ml. Concomitant therapy included PREVACID (TAP), routine vaccines and REGLAN (Unspecified). The patient experienced "intussusception" after receiving the second dose of ROTATEQ and had to be hospitalized overnight. It was reported that "patient is fine now." Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 8/22/08 Reviewed PCP office records of 6/23/2008 FINAL DX: ileocecal intussusception. Records reveal patient experienced vomiting & constipation on day of vaccination. Slept in bassinet w/bottle on side. Next vs of 7/24 was s/p overnight hospitalization for enema reduced IS. Patient had projectile vomiting & reduced oral intake. 9/5/08 Reviewed hospital medical records of 7/9-7/11/2008. FINAL DX: Intussusception Records reveal patient experienced projectile vomiting, severe abdominal pain, irritability, crying. Pt admitted for observation s/p enema reduction of IS.


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