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This is VAERS ID 272372

(NOTE: This result is from the 5/13/2011 version of the VAERS database)

Case Details

VAERS ID: 272372 (history)  
Form: Version .0  
Age: 0.2  
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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO74BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF023AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8682D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1113F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Laboratory test, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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 LABS: Barium enema attempted to reduce intussusception but was unsuccessful. WBC 15.3, alk phos 293, creatinine 0.2, BUN 14. ratio 70.
CDC Split Type:

Write-up: Vomiting on 01-17-07 with subsequent hospitatlization for intussuception requiring surgical intervention. 3/15/07 Received medical records from hospital which reveal patient experienced acute onset irritability, vomiting & bloody diarrhea for 24 hrs prior to admit on 01/17/07. Be enema unsuccessful & patient taken to OR for surgical reduction & appendectomy. Progressed well & was d/c to home on 01/18/07. Final Dx: Intussusception, surgically reduced; appendectomy.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110513&IDNUMBER=272372


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