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This is VAERS ID 272092

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

Case Details

VAERS ID: 272092 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: Nebraska  
Vaccinated:2006-12-12
Onset:2007-01-10
   Days after vaccination:29
Submitted: 2007-02-02
   Days after onset:23
Entered: 2007-02-12
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2377A / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 2 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE709AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0575 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Barium double contrast, Haematochezia, Hospitalisation, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC Split Type:

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema.


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