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This is VAERS ID 280057

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

Case Details

VAERS ID: 280057 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: California  
Vaccinated:2007-03-13
Onset:2007-05-16
   Days after vaccination:64
Submitted: 2007-05-30
   Days after onset:14
Entered: 2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 836258A / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal tenderness, Abnormal behaviour, Barium enema, Bowel sounds abnormal, Faeces discoloured
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC Split Type:

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=280057


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