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This is VAERS ID 267879

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

Case Details

VAERS ID: 267879 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Texas  
Vaccinated:2006-11-03
Onset:2006-11-24
   Days after vaccination:21
Submitted: 2006-11-28
   Days after onset:4
Entered: 2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Z0420 / 0 RL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Crying, Haematochezia, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ischaemic colitis (broad), Depression (excl suicide and self injury) (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=267879


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