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This is VAERS ID 278796

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 278796 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Louisiana  
Vaccinated:2007-04-04
Onset:2007-05-15
   Days after vaccination:41
Submitted: 2007-05-17
   Days after onset:2
Entered: 2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Body temperature increased, Bowel sounds abnormal, Infrequent bowel movements, Intussusception, Laparotomy, Nausea, Urinary system X-ray, Vomiting, X-ray with contrast upper gastrointestinal tract
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC Split Type:

Write-up: Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with decreased bowel sounds, non tender. no masses.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=278796


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