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This is VAERS ID 272460

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

Case Details

VAERS ID: 272460 (history)  
Form: Version .0  
Age: 0.7  
Gender: Male  
Location: Missouri  
Vaccinated:2007-01-03
Onset:2007-02-03
   Days after vaccination:31
Submitted: 2007-02-17
   Days after onset:14
Entered: 2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE992AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Antimicrobial susceptibility test resistant, Barium enema, Blood culture negative, Computerised tomogram abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: URI
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Abdominal ultrasound on 2/7/2007 demonstrated intussception
CDC Split Type:

Write-up: Patient developed GI symptoms (vomiting) on 2/3/2007 (31 days after receiving 3rd Rotateq). Was diagnosed with intussception on 2/7/2007. Suffered perforation of intestine during attempt to reduce by Barium enema, requiring emergent laparotomy and rean"astomosis of small bowel. Suffered a 2nd bowel perforation on 2/12/2007. Illness resulted in ICU admission, intubation, probable sepsis.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=272460


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