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This is VAERS ID 274768

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

Case Details

VAERS ID: 274768 (history)  
Form: Version .0  
Age: 0.7  
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
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF077AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal pain, Appendicectomy, Barium double contrast
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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.
CDC Split Type:

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=274768


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