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This is VAERS ID 333225

Case Details

VAERS ID: 333225 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Arizona  
Vaccinated:2008-11-07
Onset:2008-11-12
   Days after vaccination:5
Submitted: 2008-11-20
   Days after onset:8
Entered: 2008-11-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957A / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF505AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1109 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 027701 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0690X / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, No reaction on previous exposure to drug
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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. US Abd (+) for ileocolic IS. Air contras enema (+) for IS. CT brain (+) minimal prominence of ventricles, otherwise WNL. UA (+) for trace protein. AST 381. ALT 492.
CDC Split Type: WAES0811USA02377

Write-up: Information has been received from a physician concerning a 13 week old male who did not have any adverse effect from his first dose of ROTATEQ (lot # 660683/0309X) which was given on 19-SEP-2008. On 07-NOV-2008, the patient was vaccinated with ROTATEQ (lot # 661736/0690X) for his second dose. Concomitant therapy also given on 07-NOV-2008 included PREVNAR, ENGERIX-B, ACTHIB, poliovirus vaccine, DTaP and DT. On 12-NOV-2008, the patient experienced intussusceptions, medical attention was sought and was hospitalized. The patient stayed overnight in the hospital. At the time of reporting, the outcome was unknown. Additional information has been requested. 11/28/08 MR received for DOS 11/12-13/2008 with D/C DX: Intussusception. Pt presented to ER with increasing irritability, decreased po intake and constant head shaking. Vomited x 2 upon arrival at ER. PE (+) for palpable mass on RLQ/mid abdomen. Following US confirmation of ileocolic IS, an air contrast enema successfully reduced IS. Tolerated feeds well post procedure. D/C next day.


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