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This is VAERS ID 282853

(NOTE: This result is from the 5/13/2013 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) / PFIZER/WYETH E36258 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium double contrast, Blood alkaline phosphatase increased, Blood culture negative, Blood glucose increased, Enema administration, Haematemesis, Infrequent bowel movements, Intussusception, Laparoscopy, Lethargy, Melaena, Pallor, Pyrexia, Vomiting
SMQs:, Liver related investigations, signs and symptoms (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (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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