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This is VAERS ID 280707

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

VAERS ID: 280707 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Texas  
Vaccinated:2007-04-02
Onset:2007-05-06
   Days after vaccination:34
Submitted: 2007-06-06
   Days after onset:31
Entered: 2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Barium double contrast, Blood gases abnormal, Decreased appetite, Diarrhoea, Intussusception, Ultrasound abdomen abnormal, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Lactic acidosis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), 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: None.~ ()~~0~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound con
CDC Split Type:

Write-up: ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''findings highly suggestive of ileocolic intussusception. tx ''Air reduction.'' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, nonbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100831&IDNUMBER=280707


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