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This is VAERS ID 338639

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 338639 (history)  
Form: Version 1.0  
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 / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 3 MO / PO

Administered by: Private       Purchased by: Public
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? 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=20180214&IDNUMBER=338639


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