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This is VAERS ID 273046

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

Case Details

VAERS ID: 273046 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: Kentucky  
Vaccinated:2007-02-23
Onset:2007-02-24
   Days after vaccination:1
Submitted: 2007-02-26
   Days after onset:2
Entered: 2007-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258D / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Enema administration, Intussusception, Mucous stools
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Ischaemic colitis (broad)

Life Threatening? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery
CDC Split Type:

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=273046


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