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This is VAERS ID 279922

(NOTE: This result is from the 5/13/2013 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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691E / 0 UN / IM
RV5: 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, Haematochezia, Intussusception, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (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), 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. PMH: RSV. reflux. NKDA.
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. 06/04/2007 MR received for o/n hospital stay for c/o decreased po, crying, vomiting and blood in diaper. Reduced with Barium enema. DX Intussusception. Repeat ER visit 5/23/07 with c/o diarrhea and decreased appetite. DX: Enteritis.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=279922


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