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This is VAERS ID 341225

Case Details

VAERS ID: 341225 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Iowa  
Vaccinated:2008-11-17
Onset:2008-11-20
   Days after vaccination:3
Submitted: 2009-03-05
   Days after onset:105
Entered: 2009-03-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF515AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C68309 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0925X / 2 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PRILOSEC
Current Illness:
Preexisting Conditions: Gastrooesophageal reflux; Omphalitis . PMH: lingual frenulum release
Allergies:
Diagnostic Lab Data: Unknown Labs and diagnostics: Abd US (+) for ileocolic IS. Abd X-ray (+) for SBO. Air enema (+) for IS. WBC 18.1.
CDC Split Type: WAES0903USA00374

Write-up: Information has been received from a physician concerning an 18 week old male patient with a history of reflux and umbilical infection when he was born who on 16-SEP-2008 was vaccinated with the first 2 ml po dose of ROTATEQ. On 17-NOV-2008 the patient was vaccinated with the second 2 ml po dose of ROTATEQ (lot # 662618/0925X). Concomitant therapy included PRILOSEC. Subsequently, the patient experienced intussusception and was hospitalized on 20-NOV-2008. On 22-NOV-2008 the patient was diagnosed with intussusception. The physician decided not to administer the third dose of ROTATEQ. Abdominal surgery was performed and was noted by the reporting physician to be an other important medical event. At the time of reporting, the patient had recovered. Additional information has been requested. 3/23/09 MR received for DOS 11/22-24/2008 with D/C DX: Intussusception. pt presented with several week hx of intolerance to feedings. On 11/20/08 became irritable and fussy, had rust colored urine and vomited large amt. Admitted to local hospital for suspected gastritis. Bilateral hydrocele noted in scrotum with concern for SBO. Transfered to current hospital where abd US confirmed IS. Attempted reduction with air enema failed. To OR for ex lap and reduction. Did well post-op and d/c. F/u 12/16/08-recovered.


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