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This is VAERS ID 273890

Case Details

VAERS ID: 273890 (history)  
Form: Version 1.0  
Age: 0.16  
Gender: Male  
Location: Washington  
Vaccinated:2007-01-23
Onset:2007-03-10
   Days after vaccination:46
Submitted: 2007-03-13
   Days after onset:2
Entered: 2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO52AA / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8666A / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Enema administration, Intussusception, Laboratory test, Ultrasound scan
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC Split Type:

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondistened and nontender.


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