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This is VAERS ID 282853

Case Details

VAERS ID: 282853 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-04-10
Onset:2007-06-12
   Days after vaccination:63
Submitted: 2007-06-14
   Days after onset:2
Entered: 2007-06-26
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 3 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E36258 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Enema administration, Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC Split Type:

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


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