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This is VAERS ID 273125

Case Details

VAERS ID: 273125 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: New York  
Vaccinated:2007-01-17
Onset:2007-02-20
   Days after vaccination:34
Submitted: 2007-02-27
   Days after onset:7
Entered: 2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE915AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Crying, Feeding disorder of infancy or early childhood, Insomnia, Intussusception, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines


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