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This is VAERS ID 270992

Case Details

VAERS ID: 270992 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Male  
Location: North Carolina  
Vaccinated:2006-10-30
Onset:2007-01-11
   Days after vaccination:73
Submitted: 2007-01-22
   Days after onset:11
Entered: 2007-01-24
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658A / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Haematochezia, Intussusception, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC Split Type: NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.


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