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This is VAERS ID 265451

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

VAERS ID: 265451 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Nebraska  
Vaccinated:2006-10-11
Onset:2006-10-14
   Days after vaccination:3
Submitted: 2006-10-26
   Days after onset:12
Entered: 2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR, INC. 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased
SMQs:, Haematopoietic erythropenia (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admi
CDC Split Type:

Write-up: Intussusception resulting in surgical procedure and partial bowel resection.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=265451


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