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This is VAERS ID 279026

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 279026 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Alabama  
Vaccinated:2007-05-08
Onset:2007-05-13
   Days after vaccination:5
Submitted: 2007-05-19
   Days after onset:6
Entered: 2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal pain, Barium double contrast, Barium enema, Colectomy
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~0~In Patient|none~ ()~~0~In Sibling|none~ ()~~0~In Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS
CDC Split Type: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/blo"ody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bl


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