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This is VAERS ID 270981

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 270981 (history)  
Form: Version .0  
Age: 0.17  
Gender: Male  
Location: California  
   Days after vaccination:29
Submitted: 2007-01-23
   Days after onset:15
Entered: 2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Ultrasound abdomen, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC Split Type:

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/07 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduction attempt 3 times which reduced from sigmoid colon to ileocecal valve but not beyond valve. PMHX: none Underwent surgical correction for intussusception on 1/9/07- also performed appendectomy. On post op day 3 had mild abdominal distention but bowel sounds were present. BMs were normal. DC home.

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