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This is VAERS ID 278302

Case Details

VAERS ID: 278302 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Male  
Location: Texas  
Vaccinated:2007-03-24
Onset:2007-04-30
   Days after vaccination:37
Submitted: 2007-05-10
   Days after onset:10
Entered: 2007-05-12
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808672E / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 3 - / -

Administered by: Private       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC Split Type:

Write-up: Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienced vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/air contrast enema.


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