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This is VAERS ID 278389

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

Case Details

VAERS ID: 278389 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Arkansas  
Vaccinated:2007-04-13
Onset:2007-05-01
   Days after vaccination:18
Submitted: 2007-05-11
   Days after onset:10
Entered: 2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8691 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Appendicectomy, Decreased appetite, Dehydration, Enema administration
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC Split Type:

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=278389


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