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This is VAERS ID 379327

Case Details

VAERS ID: 379327 (history)  
Form: Version 1.0  
Age: 0.51  
Sex: Male  
Location: New York  
Vaccinated:2009-03-30
Onset:2009-04-14
   Days after vaccination:15
Submitted: 2010-02-03
   Days after onset:295
Entered: 2010-02-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1269X / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1001USA03375

Write-up: Information has been received from a physician concerning a 6 month old male who was vaccinated with three doses of ROTATEQ. Two weeks after the third dose, the patient was hospitalized with intussusception. This occurred a few months ago. The patient had surgery, and was fine at the time of report. Intussusception was considered to be immediately life-threatening, and an other important medical event. Additional information has been requested.


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