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This is VAERS ID 272372

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

Case Details

VAERS ID: 272372 (history)  
Form: Version .0  
Age: 0.1  
Gender: Male  
Location: Texas  
Vaccinated:2006-12-06
Onset:2007-01-17
   Days after vaccination:42
Submitted: 2007-02-15
   Days after onset:29
Entered: 2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO74BA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF023AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO8682D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Blood alkaline phosphatase increased, Blood creatinine decreased, Blood urea nitrogen/creatinine ratio increased, Diarrhoea haemorrhagic
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Biliary system related investigations, signs and symptoms (broad), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Labs and UGI on hospitalization
CDC Split Type:

Write-up: Vomiting on 01-17-07 with subsequent hospitatlization for intussuception requiring surgical intervention.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=272372


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