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This is VAERS ID 277820

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

Case Details

VAERS ID: 277820 (history)  
Form: Version .0  
Age: 0.6  
Gender: Female  
Location: Texas  
Vaccinated:2007-04-21
Onset:2007-04-29
   Days after vaccination:8
Submitted: 2007-05-02
   Days after onset:3
Entered: 2007-05-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2552AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE981AA / 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20547 / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086820 / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Screaming, Sleep disorder, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow
CDC Split Type:

Write-up: Intussusception, increased screaming, vomit, deep sleep


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=277820


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