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This is VAERS ID 279922

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 279922 (history)  
Form: Version 1.0  
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 / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691E / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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 with intussusception showing a mass in the right mid and upper abdomen c/w ileocolic intussusception. Therapeutic enema with gastrografin was showed a "probably sucessful reduction of ileocolic IS. Repeat showed no evidence of IS however no reflux into terminal ileum was obtained. ABD X-ray 5/23/2007 WNL.
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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