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This is VAERS ID 341802

Case Details

VAERS ID: 341802 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2008-12-29
Onset:2009-01-15
   Days after vaccination:17
Submitted: 2009-03-10
   Days after onset:53
Entered: 2009-03-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B198BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF520AA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH C99098 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0966X / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC for GERD 2
Current Illness: None
Preexisting Conditions: None; except GERD 2 PMH: RSV bronchiolitis
Allergies:
Diagnostic Lab Data: 1/15/09 LABS: abdominal x-ray neg. US abdomen (+) IS. Air contrast barium enema unsuccessful.
CDC Split Type:

Write-up: About 2 weeks s/p ROTATEQ vaccine, child had intussusception. Vaccine 12/29/09, admitted for intussusception 1/15/09. 3/26/09 Received hospital medical records of 1/15-1/17/2009. FINAL DX: Intussusception s/p exp laparotomy w/reduction of IS & appendectomy Records reveal patient experienced anorexia, diet refusal, increased irritability, occasional emesis x 3 days, no BM x 2 days & abdominal pain x 1 day. Had bloody stool in ER. Surgery consult done. Enema did not reduce IS & taken to OR. Progressed well, diet advanced & d/c to home w/surgery f/u. Returned to ER 1/22/09 due to vomiting, diarrhea & irritability & apparent abdominal pain. FINAL DX: gastroenteritis Surgery consult done. LABS: abdominal x-ray & US (-).


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