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This is VAERS ID 383987

Case Details

VAERS ID: 383987 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Unknown  
Location: California  
Vaccinated:2010-02-23
Onset:2010-03-02
   Days after vaccination:7
Submitted: 2010-03-31
   Days after onset:28
Entered: 2010-04-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Barium double contrast, Crying, Intussusception, Laboratory test
SMQs:, Gastrointestinal obstruction (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1003USA03773

Write-up: Information has been received from a physician concerning a 12 week old patient who "last month", on approximately 23-FEB-2010, was vaccinated with a first dose of ROTATEQ (oral route, lot # unknown). Concomitant therapy included PENTACEL and PREVNAR (lot # not reported) also administered "last month". The physician reported that "a week after getting the vaccines", on approximately 02-MAR-2010, the patient was crying and was taken to the hospital, the patient was diagnosed with intussusception, was admitted and treated with Air contrast enema and the intussusception resolved. Lab diagnostic studies performed were unspecified. The patient was seen last month for a follow-up visit and the patient had recovered. Additional information has been requested.


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