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This is VAERS ID 338775

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 338775 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Foreign  
Vaccinated:2008-12-22
Onset:2009-01-04
   Days after vaccination:13
Submitted: 2009-01-30
   Days after onset:26
Entered: 2009-02-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHEP: DTP + HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal distension, Congenital anomaly, Death, Decreased activity, Dehydration, Diarrhoea, Faeces discoloured, Gastrointestinal necrosis, Haematochezia, Intussusception, Lethargy, Nausea, Pallor, Pyrexia, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-01-08
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Malnutrition; prophylaxis
Preexisting Conditions: Scabies infestation; Pediculosis corporis; Immunisation
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0901CRI00001

Write-up: Information has been received from a physician concerning a 19 week old female with malnutrition and a history of lice infestation, scabies infestation and vaccination BCG on 21-Aug-08 who on 24-Oct-2008 received first vaccination of ROTATEQ and second vaccination on 22-Dec-2008. Concomitant vaccine therapy included the first and second doses of PENTAVALENTE and polio given on 24-Oct-08 and 22-Dec-08. On 08-Jan-2009 the patient died. The cause of death was intussusception. Infant started vomiting and nauseas within the 5 previous days (#5 a day) before visiting the hospital. Treated with oral rehydration solution at health care center two days before. Signs and symptoms registered: Diarrhea with mucus, green-colored, no blood (however mother referred bloody stools), twice a day, no abdominal pain. Treated with laxatives by non-medical personnel. Clinical symptoms remained the same for 2 days, then starts fever. Physical Evaluation: FC 160x FR 48 t 39 height 62 cm. Hypoactive, lethargic, dehydration signs, with fever, pale and showing sign of capillary fragility. Capillary refill 4 seconds; abdominal distention = 42 cm, no mass or abdominal pain. Rectum and anus: normal. On January 2009 (day unknown) patient required surgery for intestinal necrosis ileo-colic section. Surgeon stated an intestinal invagination probably associated to congenital malformation of the intestine. Additional information has been request.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=338775


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