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This is VAERS ID 278725

(NOTE: This result is from the 5/14/2017 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) / PFIZER/WYETH B08657B / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 3 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Medication error, Wrong drug administered
SMQs:, Gastrointestinal obstruction (narrow), Medication errors (narrow)

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.


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