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This is VAERS ID 277125

(NOTE: This result is from the 8/31/2010 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) / PFIZER/WYETH 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, Cough, Diarrhoea, Gastroenteritis, Haematochezia, Intussusception, Laparoscopy, Polymerase chain reaction, Rhinorrhoea, Rotavirus test negative, Sneezing, Surgery, Ultrasound abdomen abnormal, Virus serology test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), 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? 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 LABS: nasopharyngeal c/s +adenovirus. Rotavirus antigen neg. Abdominal x-ray revealed possible IS. US of abdomen revealed +IS. Barium enema attempt to reduce IS was unsuccessful.
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. 6/1/07 Received vax record from PCP which indicates RO Lot # is as reported & was 2nd dose. VAERS database updated w/same. 6/5/07 Received hospital medical records which reveal patient experienced diarrhea x 7 days, bloody mucous x 1 day & abdominal pain. Also w/rhinorrhea, cough & sneeze. Admitted 4/14-4/17/07 for bacterial gastroenteritis. On initial hospital day had coffee ground emesis. Taken to OR for laproscopic reduction of IS & appendectomy. Stable post op FINAL DX: Ileocolic intussusception, surgically reduced; adenovirus.


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