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This is VAERS ID 274772

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

Case Details

VAERS ID: 274772 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Louisiana  
Vaccinated:2007-01-09
Onset:2007-03-12
   Days after vaccination:62
Submitted: 2007-03-26
   Days after onset:14
Entered: 2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BC03AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1159R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08657F / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, Intussusception
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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Unsure - dad reported patient brought to ER for abdominal pain and was diagnosed with intussusception and had it surgically repaired at facility reported. Patient never seen here for that problem.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=274772


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