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This is VAERS ID 277955

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

Case Details

VAERS ID: 277955 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Montana  
Vaccinated:2006-11-29
Onset:2007-04-21
   Days after vaccination:143
Submitted: 2007-05-04
   Days after onset:13
Entered: 2007-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B074AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 0278F / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08683D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0278F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal mass, Abdominal pain, Abnormal behaviour, Band neutrophil count increased
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), 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:
Current Illness: unknown
Preexisting Conditions: extensive port wine stain on lower extremities with resultant leg assymetry
Allergies:
Diagnostic Lab Data: LABS: WBC low at 5.2, neutros elevated at 38, bandss elevated at 15, lymphs low at 39 w/markedly reactive lymphs noted. Creatinine low at 0.33. Na elevated at 145.
CDC Split Type:

Write-up: Patient received rotavirus vaccines on 11/29/2006 and 1/22/2007. Patient presented on 4/21/07 with a 1 day h/o episodic fussyness, vomiting a few times, clingy, tired between episodes, pale. Seen in clinic 5 days prior with cold symptoms and fever and d"iagnosed with an AOM and placed on amoxicillin. Had a few day h/o diarrhea without blood a few days ago which resolved. Cold symptoms improving. Barium enema revealed intussusception from ileocecal area completely through ascending colon which reduced


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