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This is VAERS ID 282594

(NOTE: This result is from the 5/14/2017 version of the VAERS database)

Case Details

VAERS ID: 282594 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Texas  
Vaccinated:2007-05-02
Onset:2007-05-28
   Days after vaccination:26
Submitted: 2007-06-21
   Days after onset:24
Entered: 2007-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE991AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510E / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0234U / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Barium double contrast, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: at hospital-abdominal x-ray and air contrast barium enema
CDC Split Type:

Write-up: Pt received two doses of Rotateq. Pt was sent to hospital on 5/28/07 for excessive vomiting. It was concluded that pt had intussusception. 6/22/07 Received PCP med recs which included hospital D/C summary & vax record which confirms RO lot & dose number as reported & includes other vax received same date. VAERS database updated w/same. D/C Summary reveals patient admitted 5/28-5/29/07 for vomiting & abdominal pain. Progressed we// & d/c to home. LABS: abdominal x-ray. air contrast barium enema + for IS. FINAL DX: Intussusception. 07/27/07 Received hospital medical records which reveal patient experienced fever, vomiting, heme (+) stool & abdominal pain. Admitted 5/28-5/29/07 for observation s/p reduction of intussusception by air contrast barium enema. FINAL DX: Intussusception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170514&IDNUMBER=282594


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