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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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