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This is VAERS ID 267839

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

Case Details

VAERS ID: 267839 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Colorado  
Vaccinated:2006-11-06
Onset:2006-11-06
   Days after vaccination:0
Submitted: 2006-11-07
   Days after onset:1
Entered: 2006-11-27
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B071AA / - LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. UF016AA / - LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08646E / - RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0941F / - - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Air enema, abdominal x-ray, CBC, chem profile
CDC Split Type:

Write-up: Onset of vomiting and bloody stool 3-4 hours after administration of vaccines. Patient seen in emergency room and diagnosed with intussusception, reduced with air enema.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=267839


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