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This is VAERS ID 274768

Case Details

VAERS ID: 274768 (history)  
Form: Version 1.0  
Age: 0.65  
Gender: Male  
Location: Indiana  
Vaccinated:2007-03-02
Onset:2007-03-05
   Days after vaccination:3
Submitted: 2007-03-13
   Days after onset:7
Entered: 2007-03-26
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF077AA / 3 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium enema. ileocolic intussusception that reduced easily from distal transverse colon to ileoceal valve but was unable to completely reduce the intussusception despite several attempts.
CDC Split Type:

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.


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