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This is VAERS ID 278155

(NOTE: This result is from the 7/7/2013 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
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal pain, Abdominal pain upper, Barium enema, Blood chloride, Blood creatinine, Blood glucose, Blood potassium, Blood urea, C-reactive protein increased, Carbon dioxide normal, Constipation, Diarrhoea, Enema administration, Ileus paralytic, Intussusception, Laboratory test, Lethargy, Liver function test, Opisthotonus, Platelet count, Pyrexia, Screaming, Vomiting, White blood cell count
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)

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. PMH: none. NKDA.
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. Labs and Diagnostics: Abdominal X-rays x
CDC Split Type:

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in 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. 07/02/2007 MR received for hospital stay 4/19-21/2007. Infant developed intermittant, severe abdominal pain (evidenced by back arching and screaming) and emesis 5 days prior to admission. Seen in ER x 2 for above and progression to bilious vomiting and acting "lifeless". 2nd ER visit with DX of constipation and enema given with improvement initially. Symptoms reoccured and child was admitted. Barium enema succesfully reduced intussusception. Feeding, stooling, and voiding well post procedure. DX: c/w Intussusception.


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