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This is VAERS ID 270992

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 270992 (history)  
Form: Version .0  
Age: 0.2  
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
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658A / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal discomfort, Haematochezia, Intussusception, Lethargy, Pallor
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (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:

Write-up: Bloody stool, intussusception, requiring surgery.


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