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This is VAERS ID 382948

Case Details

VAERS ID: 382948 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Female  
Location: Texas  
Vaccinated:2010-03-01
Onset:2010-03-03
   Days after vaccination:2
Submitted: 2010-03-17
   Days after onset:13
Entered: 2010-03-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3335AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90887 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Abdominal tenderness, Diet refusal, Intussusception, Malaise, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: barium enema x-ray, 03/04/10, unsuccessful.
CDC Split Type: WAES1003USA01103

Write-up: Information has been received from a physician concerning a 4 month old female patient, with no pertinent medical history and no known drug allergies, who on 22-DEC-2009, was vaccinated with a first dose of ROTATEQ (dose, route and lot number not provided). On 03-MAR-2010, the patient received orally the second "0.2 mL" dose of ROTATEQ (lot number 664874/1213Y). Another vaccines administered on the same day included PENTACEL and PREVNAR. Concomitant therapy included an antibiotic (not specified) for the strep throat. On 03-MAR-2010, the patient was admitted in the hospital for intussusceptions after getting ROTATEQ. The physician stated that on 03-MAR-2010, the first symptoms appeared in the form of non-bilious vomiting, not eating, and malaise. Later that day, the patient was taken to the emergency room at the hospital. No computed axial tomography scans or ultrasounds were performed, as it was initially thought the patient had gastroenteritis. There were no bloody stools. Patient was admitted and treated with IV fluids. On 04-MAR-2010, examination showed abdominal tenderness and an unsuccessful barium enema was done. On the same day, the patient had surgery where the intussusception was manually reduced. No predisposing conditions. After surgery, the patient was doing better. The baby was full term. At the time of reporting, the patient had recovered. The physician considered intussusceptions to be disabling and life threatening. No further information is available. On 03-MAR-2010, the patient was admitted in the hospital.


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