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This is VAERS ID 267839

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 267839 (history)  
Form: Version 1.0  
Age: 0.36  
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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF016AA / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646E / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / UNK MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Haematochezia, Intussusception, Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypoglycaemia (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 Birth HX: c section at term. Uncomplicated
Allergies:
Diagnostic Lab Data: Air enema, abdominal x-ray, CBC, chem profile LABS: WBC 19.7, H/H 11.9/35
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. 12/19/06 Received medical records from ER which reveal patient seen 11/06/06 s/p vomiting & bloody stool on day of vax. Afebrile. Lethargic. Hypoactive bowel sounds & palpable soft mass in RUQ with tenderness to palpation. Seen in ER at outlying hospital then transferred to facility which could provide air contrast enema. Kept in that ER for several hours s/p successful reduction for continued observation. Final DX: Intussusception, reduced by air enema.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=267839


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