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This is VAERS ID 278583

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 278583 (history)  
Form: Version .0  
Age: 0.83  
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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670E / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? 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 records received 6/20/07-air enema reduction
CDC Split Type:

Write-up: Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=278583


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