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This is VAERS ID 282853

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 282853 (history)  
Form: Version .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 / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 UN / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC E36258 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Barium double contrast, Blood alkaline phosphatase increased, Blood culture negative, Blood glucose increased, Enema administration
SMQs:, Liver related investigations, signs and symptoms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Biliary system related investigations, signs and symptoms (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
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.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=282853


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