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This is VAERS ID 386473

(NOTE: This result is from the 3/14/2015 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
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Barium enema, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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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