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This is VAERS ID 273140

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 273140 (history)  
Form: Version 1.0  
Age: 0.53  
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 / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, X-ray
SMQs:, Gastrointestinal obstruction (narrow)

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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