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This is VAERS ID 274772

(NOTE: This result is from the 5/13/2013 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
DTAPHEPBIP: 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 / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, Intussusception, Laparotomy, Surgery, Vomiting
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 records received 4/24/07-Gastrografin enema water soluble attempt unsuccessful.
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 that04/24/07-records received from facility for DOS 03/14-03/15/07. DC DX: Intussusception Ileocolic. HX of emesis and bloody stools. Gastrografin enema water soluble attempt unsuccessful. Exploratory laparotomy with manual reduction of intussusception. Incidental appendectomy. problem.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=274772


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