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This is VAERS ID 280397

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 280397 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: North Carolina  
Vaccinated:2007-03-03
Onset:2007-05-18
   Days after vaccination:76
Submitted: 2007-05-29
   Days after onset:11
Entered: 2007-06-05
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08658E / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Chest X-ray normal, Culture stool negative, Full blood count, Haematochezia, Intussusception, Laboratory test, Mucous stools, Parasite stool test negative
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobact
CDC Split Type: NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=280397


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