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This is VAERS ID 273884

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 273884 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Missouri  
Vaccinated:2007-01-25
Onset:2007-03-10
   Days after vaccination:44
Submitted: 2007-03-13
   Days after onset:2
Entered: 2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0324 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08670F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Haematochezia, Intussusception, Laparotomy, Mucous stools, Rotavirus test negative, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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: Polytrim ophthalmic
Current Illness: None known
Preexisting Conditions: Dacryostenosis
Allergies:
Diagnostic Lab Data: Air contrast enema - (+) for intususception records received 4/24/07-Colon air contrast enema revealed ileocolic intussusception. US positive for ileocolic intussusception. Labs WNL rotavirus antigen negative
CDC Split Type:

Write-up: Intususception diagnosed by hospital. 04/24/07-records received from facility for DOS 03/13-03/16/07. DC DX: Intussusception. C/O fussy for 2 days large emesis, bloody stools. Multiple mucousy bloody stools. Abdomen fullness palpated in right lower quadrant. Unsuccessful attempt at reduction via enema. Laparotomy including appendectomy.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100302&IDNUMBER=273884


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