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This is VAERS ID 277783

Case Details

VAERS ID: 277783 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Arizona  
Vaccinated:2007-03-08
Onset:2007-04-24
   Days after vaccination:47
Submitted: 2007-05-02
   Days after onset:8
Entered: 2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


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