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This is VAERS ID 277820

(NOTE: This result is from the 2/14/2017 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) / PFIZER/WYETH B086820 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Screaming, Sleep disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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 LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC Split Type:

Write-up: Intussusception, increased screaming, vomit, deep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=277820


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