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This is VAERS ID 278302

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

VAERS ID: 278302 (history)  
Form: Version .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 / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808672E / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Decreased appetite, Dehydration, Hyponatraemia, Intussusception, Lethargy, Occult blood positive, Urinary system X-ray, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (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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