National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 278725

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 278725 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: California  
Vaccinated:2007-03-15
Onset:2007-04-11
   Days after vaccination:27
Submitted: 2007-05-16
   Days after onset:35
Entered: 2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08657B / 3 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 3 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Enema administration, Intussusception, Irritability, Medication error, Occult blood positive, Pyrexia, Retching, Vomiting, Wrong drug administered
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Hostility/aggression (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: See the vaccine history attached. 8 month old baby diagnosed with intussuscetion on April 11, 2007 had third rotavirus vax on March 15. DTaP-HBV-POL (Diphtheria, Tetanus, acellular Pertussis, Hepatitis B, Polio) 3/15/2007, 1/2/2007, 10/31/2006 HBV adult (Hepatitis B) 9/1/2006 HIB PRP-OMP (Haemophilus influenzae b) 1/2/2007, 10/31/2006 PNUcn (Pneumococcal conjugate, pneumonia) 3/15/2007, 1/2/2007, 10/31/2006 ROT5 (Rotavirus live, pentavalent) 3/15/2007, 1/2/2007, 10/31/2006 6/26/07 Received hosp med recs which reveal on 4/10/07 pt experienced abdominal pain & wretching & seen in peds clinic. Referred to ER for w/u. Surg consult done. Pt d/c to home to be eval by PCP next day. FINAL DX: None provided, surgeon did not feel probable IS. 6/29/07 Received additional hospital medical records which reveal patient admitted 4/11-4/12/07 for continued fever, vomiting, irritability & abdominal pain. Found to have heme (+) stool in ER. Per MD notes, IS was reduced by barium enema but no radiology report included. FINAL DX: Intussusception, reduced by barium enema. 7/31/07 Received vax record from reporter. VAERS database updated w/same.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=278725


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166