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This is VAERS ID 273694

Case Details

VAERS ID: 273694 (history)  
Form: Version 1.0  
Age: 0.48  
Gender: Female  
Location: California  
Vaccinated:2006-12-27
Onset:2007-02-03
   Days after vaccination:38
Submitted: 2007-03-08
   Days after onset:33
Entered: 2007-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 3 LA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF021AB / 3 LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8678K / 3 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Explorative laparotomy, Intussusception, Laparotomy
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow)

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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium Enema/laparotomy Lab/diagnostics received 3/15/07-BE:intussusception to rectosigmoid only reducible to hepatic flexure. US abdomen confirmed intussusception.
CDC Split Type:

Write-up: Intussusception with exploratory laparotomy with right hemicolectomy and partial ileectomy. 03/15/07-records received from facility for DOS 2/3-2/10/07 DC DX: Intussusception status post right hemicolectomy. Previously healthy infant developed emesis and bloody mucoid stools PE:WNL except for abdomen large palpable mass in mid left which was mobile, somewhat tender to palpation and firm. Right hemicolectomy 2/4/07-


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