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This is VAERS ID 281381

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 281381 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Tennessee  
Vaccinated:2007-05-31
Onset:2007-06-05
   Days after vaccination:5
Submitted: 2007-06-07
   Days after onset:2
Entered: 2007-06-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Surgery, Urinary system X-ray
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussusception on right side which was not reduced during enema studies.
CDC Split Type:

Write-up: Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, supports submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bottles. No bowel movements since 7 a.m.PE: abdomen soft, slightly distended, positive bowel sounds. Non tender.


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