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This is VAERS ID 277125

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 277125 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2007-02-13
Onset:2007-04-14
   Days after vaccination:60
Submitted: 2007-04-20
   Days after onset:6
Entered: 2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF064AA / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0326 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258B / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal pain, Adenovirus infection, Appendicectomy, Barium enema
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
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? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: (+) adenovirus PCR
CDC Split Type:

Write-up: 4/14/07 - Presented with /"coffee ground emesis/" and bloody stools. Mom took him to ER, dx''''d with adenovirus and intussusception. Unable to reduce with barium enema reduced with surgery. S/P Appendectomy.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=277125


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