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This is VAERS ID 279922

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

Case Details

VAERS ID: 279922 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: California  
Vaccinated:2007-02-27
Onset:2007-04-16
   Days after vaccination:48
Submitted: 2007-05-29
   Days after onset:43
Entered: 2007-05-30
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08691E / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 0 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Barium enema, Crying, Enteritis, Fluid intake reduced
SMQs:, Pseudomembranous colitis (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: ABD X-ray showed non-specific gas pattern with some air fluid levels and several mildly dilated loops of bowel. Intussusception or partial bowel obstruction are not excluded. ABD US showed an appearance consistant wi
CDC Split Type:

Write-up: intussusception on 4-16-07 seen at hospital. admitted for emesis


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=279922


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