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This is VAERS ID 284252

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 284252 (history)  
Form: Version .0  
Age: 0.1  
Gender: Female  
Location: Texas  
Vaccinated:2007-04-05
Onset:2007-06-16
   Days after vaccination:72
Submitted: 2007-07-10
   Days after onset:24
Entered: 2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Barium contrast enema attempted to reduce IS but was unsuccessful.
CDC Split Type:

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


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