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This is VAERS ID 279695

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

Case Details

VAERS ID: 279695 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: New York  
Vaccinated:2007-05-04
Onset:2007-05-15
   Days after vaccination:11
Submitted: 2007-05-16
   Days after onset:1
Entered: 2007-05-25
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670D / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal mass, Abdominal tenderness, Carbon dioxide abnormal, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel.
CDC Split Type:

Write-up: Intussusception with vomiting, lethargy


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