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This is VAERS ID 338639

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 338639 (history)  
Form: Version .0  
Age: 0.5  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2009-01-27
Onset:2009-01-28
   Days after vaccination:1
Submitted: 2009-01-29
   Days after onset:1
Entered: 2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 2 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Abdominal pain, Abdominal tenderness, Barium enema abnormal, Enema administration, Haematochezia, Hypophagia, Intussusception, Irritability, Mucous stools, Nausea, Surgery, Ultrasound abdomen abnormal, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad)

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:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC Split Type:

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=338639


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