This is VAERS ID 273140

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

Case Details

VAERS ID:	273140 (history)
Form:	Version .0
Age:	0.5
Gender:	Male
Location:	Utah

Vaccinated:	2007-01-08
Onset:	2007-02-24
Days after vaccination:	47
Submitted:	2007-02-27
Days after onset:	3
Entered:	2007-02-27

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR	C2521AA / 2	LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR	U2220BB / 0	LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC.	0412F / 2	RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR	Y1031 / 2	LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B58845D / 2	RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1111F / 1	- / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC Split Type:

Write-up: INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.

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