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This is VAERS ID 354607

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 354607 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: New York  
Vaccinated:2009-07-08
Onset:2009-07-15
   Days after vaccination:7
Submitted: 2009-08-05
   Days after onset:21
Entered: 2009-08-07
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3084AA / - UN / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR B0476 / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D4687U / - UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41OA733A / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal rigidity, Ascites, Blood chloride decreased, Enema administration, Faecal volume decreased, Haematocrit decreased, Heart rate increased, Intussusception, Irritability, Lymphocyte morphology abnormal, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte percentage increased, Platelet count increased, Protein total decreased, Pyrexia, Rash, Respiratory rate increased, Ultrasound abdomen abnormal, Urine output decreased, Vomiting, White blood cell count increased
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: There were no reported concomitant medications or relevant medical history. The subject had not experienced adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK. 10/2/09 Hospital records, DC summary, received DOS 7/16/09 to 7/17/09. LABS and DIAGNOSTICS: Ultrasound Abdomen Abnormal. CBC - WBC 14.6 (H) HCT 30.2% (L) MCV 91.1 (L) MCH 31.5 MMG (L) Platelets 454 THO/UL (H) Mono 16% (H) Atyp Lymph 2
CDC Split Type: A0799191A

Write-up: This case was reported by a healthcare professional and described the occurrence of intussusception in a 2-month-old female subject who was vaccinated with ROTARIX (GlaxoSmithKline). There were no reported concomitant medications or relevant medical history. The subject had not experienced adverse events following previous vaccinations. Concurrent vaccination included DAPTACEL (non-gsk) (Sanofi) given on 8 July 2009; PREVNAR (non-gsk) (Wyeth Labs) given on 8 July 2009; IPOL (non-gsk) (Sanofi) given on 8 July 2009. On 8 July 2009 the subject received 1st dose of ROTARIX (1 ml; oral). The lot number was reported as A41OA733A. On 15 July 2009, 7 days after vaccination with ROTARIX, the subject experienced intussusception and "severe" vomiting. The subject was hospitalised and the healthcare professional considered the events were clinically significant (or requiring intervention). At the time of reporting the events were improved. The healthcare professional considered the events were probably related to vaccination with ROTARIX. 10/2/09 Hospital records, DC summary, received DOS 7/16/09 to 7/17/09. Assessment: Intussusception. Presented to ER with 2 days of increased vomiting, fussiness, and decreased stooling, no wet diapers. Fever, respirations and heart rate elevated. Rash below chin. Abdomen rigid. Symptoms resolved with air enema. Some ascites. ICD-9 Codes: 560.0 Intussusception, 276.51 Dehydration.


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