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This is VAERS ID 276038

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 276038 (history)  
Form: Version .0  
Age: 0.17  
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) / PFIZER/WYETH B08684H / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (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.


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