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This is VAERS ID 284028

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 284028 (history)  
Form: Version .0  
Age: 0.5  
Gender: Female  
Location: Georgia  
Vaccinated:2007-04-13
Onset:2007-06-23
   Days after vaccination:71
Submitted: 2007-07-06
   Days after onset:13
Entered: 2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670B / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Bowel sounds abnormal, Diarrhoea, Enema administration, Intussusception, Pallor, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t
CDC Split Type:

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=284028


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