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VAERS ID: 1000422

AGE: UNK| SEX: M|State: FR

Description

Intussusception; This is a spontaneous report from the regulatory authority. The regulatory authority number is v20100768. A contactable physician reported that a 2-month-old male infant received the first dose of pneumococcal 13-valent conjugate vaccine (diphtheria crm197 protein) (PREVENAR 13, Solution for injection in pre-filled syringe, lot number; DC9617, expiration date: 31Aug2022), via an unspecified routed of administration on 21Jan2021 12:10 at single dose for immunization, first doses of rotavirus vaccine live oral 1v (ROTARIX, GSK, lot number; RT014), hib vaccine conjugate (tetanus vaccine toxoid) (ACTHIB, Sanofi, lot number; R1F61), and hepatitis b vaccine rhbsag (yeast) (BIMMUGEN, Biologics, lot number; Y118L), all via unspecified route of administration on 21Jan2021 12:10, at 1, single for immunisation. Birth weight was 4150 g. Body temperature before vaccinations was 36.5 degrees centigrade. The infant was the 2nd child of his family. He had an elder sister. The family member had no symptom. The infant had no relevant medical history. On 24Jan2020, the infant presented with intussusception at 08:30 am. The clinical course was as follows: Bloody stool and vomiting developed at 08:30 on 24Jan2021. The infant visited the pediatric department of the reporter's hospital at 10:30. Dance sign was observed. Abdominal ultrasound showed target sign. Gastrografin barium enema examination revealed the advanced part in the ascending colon, and barium running through the ileocecum was confirmed, and then, the treatment was completed. Invagination of intestine was diagnosed and the infant was hospitalized. On 25Jan2021, no recurrence of symptoms was observed, and the infant was discharged from the hospital. The event was recovering as of 25Jan2021. The reporting physician classified the event, intussusception, as serious (hospitalization) and assessed it as related to vaccinations. There was no other factor contributing to the event. Reporter's comment: Invagination of intestine developed 3 days after the vaccinations and an adverse reaction caused by rotavirus vaccine live oral 1v was diagnosed.

Symptoms

Barium enema abnormal, Vaccination complication, Body temperature normal, Vomiting, Haematochezia, Intussusception, Ultrasound abdomen abnormal

Vaccines

VAX DATE: 20 January 2021 | ONSET DATE: 23 January 2021 | DAYS TO ONSET: 3
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • HEP
  • HIBV
  • PNC13
  • RV1
  • GLAXOSMITHKLINE BIOLOGICALS
  • PFIZERWYETH
  • SANOFI PASTEUR
  • UNKNOWN MANUFACTURER
  • HEP B (NO BRAND NAME)
  • HIB (ACTHIB)
  • PNEUMO (PREVNAR13)
  • ROTAVIRUS (ROTARIX)
  • 1
  • DC9617
  • R1F61
  • RT014
  • Y118L

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
Y
HOSPDAYS:
1
X_STAY:
DISABLE:
RECOVD:
N
LAB_DATA:
Test Date: 20210121; Test Name: Body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Test Date: 20210124; Test Name: Abdominal ultrasound; Result Unstructured Data: Test Result:target sign; Test Name: Birth weight; Test Result: 4150 g; Test Date: 20210124; Test Name: Gastrografin barium enema examination; Result Unstructured Data: Test Result:Assessment; Comments: revealed the advanced part in the ascending colon
V_ADMINBY:
OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
JPPFIZER INC2021077692
FORM_VERS:
2
TODAYS_DATE:
02 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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