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This is VAERS ID 278716

(NOTE: This result is from the 5/14/2017 version of the VAERS database)

Case Details

VAERS ID: 278716 (history)  
Form: Version .0  
Age: 0.6  
Gender: Male  
Location: Oklahoma  
Vaccinated:2007-05-14
Onset:2007-05-15
   Days after vaccination:1
Submitted: 2007-05-16
   Days after onset:1
Entered: 2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690B / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Diarrhoea, Enema administration, Intussusception, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC Split Type:

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170514&IDNUMBER=278716


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