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This is VAERS ID 380196

(NOTE: This result is from the 8/31/2010 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
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2395AA / 1 UN / IJ
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D75884 / 0 UN / IJ
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0769Y / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Dehydration, Full blood count, Intussusception, Ultrasound scan
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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? 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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