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This is VAERS ID 278155

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

Case Details

VAERS ID: 278155 (history)  
Form: Version .0  
Age: 0.6  
Gender: Male  
Location: Tennessee  
Vaccinated:2006-12-13
Onset:2007-04-15
   Days after vaccination:123
Submitted: 2007-05-03
   Days after onset:18
Entered: 2007-05-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR 42174RA / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal pain, Abdominal pain upper, Barium enema, Blood chloride
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema
CDC Split Type:

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ETCH ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=278155


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