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This is VAERS ID 274817

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 274817 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Missouri  
Vaccinated:2007-02-05
Onset:2007-03-18
   Days after vaccination:41
Submitted: 2007-03-26
   Days after onset:8
Entered: 2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B074AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0407F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B086840 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Diarrhoea haemorrhagic, Enema administration, Haematochezia, Intussusception, Ultrasound abdomen, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air contrast enema, abd ultrasound US:Instussusception identified in left upper quadrant of abdomen. Reduction with therapeutic enema. Recurrance seen on US in small ileocolic intussusception at level of cecum. Second therapeutic enema.
CDC Split Type:

Write-up: 3/18/07 went to Hospital ER for vomiting and bloody diarrhea. Diagnosed with intussusception. Treated with reduction twice. Hospitalized 3/18-3/20/07. 04/02/07-ER and Diagnostic records received from facility. US:Instussusception identified in left upper quadrant of abdomen. Reduction with therapeutic enema. Recurrance seen on US in small ileocolic intussusception at level of cecum. Second therapeutic enema. Presented with abdominal pain positive bloody stools, nonbilious emesis. Labs: WNL.


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