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This is VAERS ID 272200

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

Case Details

VAERS ID: 272200 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Texas  
Vaccinated:2006-12-19
Onset:2007-02-09
   Days after vaccination:52
Submitted: 2007-02-13
   Days after onset:4
Entered: 2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduct
CDC Split Type:

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resec"tion of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission


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