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This is VAERS ID 279290

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 279290 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: Texas  
Vaccinated:2007-04-09
Onset:2007-05-08
   Days after vaccination:29
Submitted: 2007-05-22
   Days after onset:14
Entered: 2007-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF084AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0022U / 2 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood culture negative, Body temperature increased, Culture urine negative, Decreased appetite, Diarrhoea, Faeces discoloured, Fluid replacement, Full blood count, Haematochezia, Intussusception, Laparotomy, Metabolic function test, Occult blood positive, Rotavirus test negative, Surgery, Urine analysis, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: convalescent of Ear infection and upper respiratory infection
Preexisting Conditions: allergic to amoxil medication
Allergies:
Diagnostic Lab Data: While hospitalized he had a CBC,CMP,Urinalysis,single colon barium enema exam,and the rotavirus exam.Stools were positive for guaiac,rotavirus exam was negative,electrolytes corrected and CBC was within normal range.the impression on the co
CDC Split Type:

Write-up: Patient vomited 6 times on date of service 05/09/07 and poor appetite.The day before, he vomited 3 times.We administered Phenegran 0.3ml for the vomiting.He was given pedialyte and gatorade at home.He was admitted to the hospital.He was placed on IV fluids.He had one loose stool with a little red color, the day after admission,child was distended.X-Ray suggested Intussusception and barium enema comfirmed it. surgery was done shortly after 06/05/07-records received from facility for DOS 5/9-5/11/07. DX:Intussusception. Dehydration, Left Otitis Media, Upper Respiratory Infection, Vomiting. Surgery:explaratory laporotomy with reduction of intussusception and incidental appendectomy. 48 hours prior to admission had progressive abdominal distention, vomiting and two episode of bloody stools. . Initially admitted for feeding difficulites and fever since previous night. During course of hospitalization developed diarrhea and vomiting and abdominal distention.


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