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This is VAERS ID 380196

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 380196 (history)  
Form: Version .0  
Age: 0.3  
Sex: Male  
Location: Unknown  
Vaccinated:2009-12-17
Onset:2010-01-28
   Days after vaccination:42
Submitted: 2010-02-11
   Days after onset:14
Entered: 2010-02-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0769Y / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Barium enema, Dehydration, Diarrhoea, Full blood count, Intussusception, Ultrasound scan, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: ultrasound, 01/30/10; complete blood cell, 01/30/10
CDC Split Type: WAES1002USA00791

Write-up: Information has been received from a physician concerning a 23 weeks old male with no allergies, who on 19-OCT-2009 was vaccinated with a first dose of ROTATEQ (lot number: 664070/0320Y, route not reported, expiration date: 19-OCT-2009). On 17-DEC-2009 the patient was vaccinated with a second dose of ROTATEQ (lot number: 664291/0769Y and route not reported, expiration date: 27-JAN-2009). The physician reported that the patient developed intussusception after his second dose of ROTATEQ and was hospitalized on 30-JAN-2010 with severe dehydration and was kept in the hospital until his discharge on 01-FEB-2010. The physician stated that "the patient continued to improve after discharge from the hospital and soon felt 100% better. Complete blood count and an ultrasound were performed when the patient was admitted on 30-JAN-2010 to confirm his diagnosis. Also the physician stated that "there were no plans to give the patient third dose of ROTATEQ". Therapy with ROTATEQ was discontinued on 17-DEC-2009. Intussusception and severe dehydration were considered to be immediately life-threatening. Additional information has been requested.


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