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This is VAERS ID 281061

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

Case Details

VAERS ID: 281061 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: California  
Vaccinated:2007-04-24
Onset:2007-05-29
   Days after vaccination:35
Submitted: 2007-06-08
   Days after onset:10
Entered: 2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS GSKAC14B042BA / 1 RA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR AVPPUF074AA / 1 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR AVPY1032-2 / 1 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD0779F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Barium enema, Bowel sounds abnormal, Dehydration, Diarrhoea haemorrhagic
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (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)

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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Guiac positive stools. Abdominal Ultrasound showed intussusception at RLQ, likely ileo-colic.
CDC Split Type:

Write-up: Admitted on 5/30/07 after a 2 day history of vomiting, associated with low-grade fever and 2 bouts of bloody diarrhea. Initial impression was acute gastroenteritis with dehydration. While kept NPO, he still had one episode of emesis and one episode of w"atery, pinkish-brown stools which was positive for occult blood. An abdominal series showed signs of obstruction; an abdominal ultrasound diagnosed an intussusception. The patient was transferred to Hospital on 5/31/07 for further management. A bowel en


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