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This is VAERS ID 281725

Case Details

VAERS ID: 281725 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: California  
Vaccinated:2007-04-12
Onset:2007-05-30
   Days after vaccination:48
Submitted: 2007-06-06
   Days after onset:7
Entered: 2007-06-14
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Irritability, X-ray
SMQs:, Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC Split Type:

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


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