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This is VAERS ID 386473

(NOTE: This result is from the 6/11/2011 version of the VAERS database)

Case Details

VAERS ID: 386473 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Alabama  
Vaccinated:2010-03-08
Onset:2010-04-15
   Days after vaccination:38
Submitted: 2010-04-30
   Days after onset:15
Entered: 2010-05-03
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110611&IDNUMBER=386473


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