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This is VAERS ID 273046

(NOTE: This result is from the 4/7/2010 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
DTAPHEPBIP: 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: Private
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Enema administration, Intussusception, Mucous stools, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), 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 (narrow), 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 LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
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. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=273046


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