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This is VAERS ID 273010

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

Case Details

VAERS ID: 273010 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Mississippi  
Vaccinated:2006-12-29
Onset:2007-02-23
   Days after vaccination:56
Submitted: 2007-02-26
   Days after onset:3
Entered: 2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0658F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Intussusception
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

Life Threatening? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays and barium enema LABS: X-ray suspicious for IS, confirmed by bariem enema & successfully reduced.
CDC Split Type:

Write-up: Pt received Rotateq #1 12/29/06. Pt developed intussusception 2/23/07 which was successfully reduced by barium enema. Child did well following reduction without significant sequelae. 3/15/07 Received medical records from hospital which reveal patient experienced loose stools 1 of which was bloody. Became lethargic w/low grade fever. BE enema successful. Held overnight for observation. Did well & was d/c home next day. FINAL DX: Intussusception, successfully reduced w/BE enema.


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