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This is VAERS ID 281061

(NOTE: This result is from the 5/14/2017 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
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD0779F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Gastroenteritis, Intussusception, Occult blood positive, Pyrexia, Ultrasound abdomen, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Guiac positive stools. Abdominal Ultrasound showed intussusception at RLQ, likely ileo-colic. Labs and Diagnostics: Abd x-ray (+) for obstruction. Abd. US (+) for intussusception of the RLQ. ? ilecolic with obstruction. KUB and Barium enema done upon arrival at transfer facility.
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 watery, 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 enema was performed, which was able to reduce the intussusception. The patient was discharged 24 hours after the procedure. 07/02/2007 Hospital records received from both admitting and transfer hospitals. Infant was initially seen and admitted for c/o bloody/mucusy stool and vomiting with each breast feed. PE significant for hypoactive BS, otherwise WNL. Infant transfered to another facility for management. Intussusception was sucessfully reduced via Hypaque enema. Principal DX: Intussusception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170514&IDNUMBER=281061


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