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This is VAERS ID 269344

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 269344 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: California  
Vaccinated:2006-11-02
Onset:2006-12-08
   Days after vaccination:36
Submitted: 2006-12-15
   Days after onset:7
Entered: 2006-12-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2490AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0268F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08681F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 - / PO

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

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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Hydrocele, cafe on lait macules-multiple (No NF)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting and lethargy, intussusception, required surgery for resection at necrotic bowel.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100302&IDNUMBER=269344


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