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This is VAERS ID 337444

Case Details

VAERS ID: 337444 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Unknown  
Location: Unknown  
Vaccinated:2008-12-04
Onset:2009-01-06
   Days after vaccination:33
Submitted: 2009-01-14
   Days after onset:8
Entered: 2009-01-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3180AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0726X / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH DL6279 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Surgery
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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS
CDC Split Type: WAES0901USA00993

Write-up: Information has been received from a physician''s assistant (P.A.) concerning a approximately 3 month old patient who was vaccinated with a dose of ROTATEQ (lot # not reported) at the age of 6 weeks, in approximately Nov 2008. It was reported that the patient experienced intussusception "at 3 months of age", in approximately Jan 2009. Unspecified medical attention was sought. The baby had surgery and was hospitalized on 07-JAN-2009. As of 08-JAN-2009, the patient''s outcome was unknown. Intussusception was considered to be an other important medical event by the reporter. Additional information has been requested. 2/17/09 MR received for DOS 1/7-10/2009 with D/C DX: Intussusception. Pt presented with 1 day hx of persistant nausea with bilious emesis, decreased UO, obstipation, lethargy and irritability. PE (+) for RLQ tenderness. IS noted on US. Reduction attempted with air contrast enema, but unsucessful. To OR for exploratory lap and reduction. Bowel fxn returned 24 hrs post-op and diet advanced. D/C home 1/10/09. .


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