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This is VAERS ID 277882

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 277882 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-04-03
Onset:2007-04-26
   Days after vaccination:23
Submitted: 2007-05-03
   Days after onset:7
Entered: 2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672K / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium double contrast, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air. LABS: heme (+) stool. US (+) for IS in transverse colon. Blood work WNL. Abd x-ray suspicious for IS. Air enema successfully reduced IS.
CDC Split Type:

Write-up: Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation. 5/4/07 Received vax records from PCP which confirm RO lot & dose as reported on VAERS form. 7/6/07 Received hospital medical records which reveal patient experienced bilious emesis & had blood in stool in ER. Surgery consult done. Admitted 4/27-4/28/07. FINAL DX: Ileocolic intussusception, successfully reduced by air enema.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=277882


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