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This is VAERS ID 281725

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 281725 (history)  
Form: Version .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 / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689D / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood test normal, Crying, Decreased appetite, Intussusception, Irritability, Screaming, Somnolence, Urinary system X-ray, X-ray
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (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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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=281725


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