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This is VAERS ID 323038

Case Details

VAERS ID: 323038 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Male  
Location: California  
Vaccinated:2008-05-22
Onset:2008-07-30
   Days after vaccination:69
Submitted: 2008-08-15
   Days after onset:16
Entered: 2008-08-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Haematochezia, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC Split Type:

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


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