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This is VAERS ID 274629

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 274629 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: D.C.  
Vaccinated:2007-03-20
Onset:2007-03-22
   Days after vaccination:2
Submitted: 2007-03-23
   Days after onset:1
Entered: 2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08655E / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Barium enema, Colostomy, Explorative laparotomy, Gastrooesophageal reflux disease
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific dysfunction (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION,
Preexisting Conditions: PER 18
Allergies:
Diagnostic Lab Data: ABD XR
CDC Split Type:

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=274629


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