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This is VAERS ID 276539

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 276539 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Vermont  
Vaccinated:2007-02-01
Onset:2007-04-08
   Days after vaccination:66
Submitted: 2007-04-10
   Days after onset:2
Entered: 2007-04-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Explorative laparotomy, Intussusception, Surgery
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC Split Type:

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=276539


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