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This is VAERS ID 275635

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 275635 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Maryland  
Vaccinated:2007-01-23
Onset:2007-02-11
   Days after vaccination:19
Submitted: 2007-04-05
   Days after onset:52
Entered: 2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Barium enema, Blood culture negative, Culture urine negative, Decreased appetite, Explorative laparotomy, Full blood count normal, Haematochezia, Intussusception, Laboratory test normal, Nausea, Surgery, Urine analysis normal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC Split Type:

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=275635


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