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This is VAERS ID 278796

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 278796 (history)  
Form: Version 1.0  
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 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689C / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray with contrast upper gastrointestinal tract
SMQs:, Gastrointestinal obstruction (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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