National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 276038

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

Case Details

VAERS ID: 276038 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2007-01-15
Onset:2007-01-21
   Days after vaccination:6
Submitted: 2007-04-11
   Days after onset:79
Entered: 2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059DA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0719R / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08684H / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium double contrast, Decreased appetite, Explorative laparotomy, Gastrointestinal necrosis, Haematochezia, Intussusception, Purulent discharge, Surgery, Ultrasound abdomen abnormal, 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 (narrow)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: x ray etc. LABS: Abdominal US revealed IS. Air contrast barium enema failed x 4.
CDC Split Type:

Write-up: intussusception diagnosed & operated 6 days later. 4/24/07 Received medical records from hospital which reveal patient experienced a 1 day hx of bloody stools & emesis with decreased appetite. Had been transferred from outlying hospital. Admitted1/21/07-1/25/07. Surg consult done & taken to OR for exp lap & ileocecectomy w/primary anastomosis. During surgery there was diffuse purulent fluid found in peritoneum w/necrotic IS. Patient progressed well & was d/c to home FINAL DX: Intussusception, surgically reduced.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=276038


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166