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This is VAERS ID 278583

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

Case Details

VAERS ID: 278583 (history)  
Form: Version .0  
Age: 0.8  
Gender: Male  
Location: Colorado  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-05-07
Entered: 2007-05-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670E / 2 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Barium double contrast, Decreased appetite, Dehydration, Intussusception
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Air enema diagnosed and reduced obstruction
CDC Split Type:

Write-up: Vomiting, dehydration, had intussusception reduced with air enema.


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