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This is VAERS ID 284308

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

VAERS ID: 284308 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2007-06-07
Onset:2007-06-30
   Days after vaccination:23
Submitted: 2007-07-08
   Days after onset:8
Entered: 2007-07-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Appendicectomy, Blood potassium decreased, Culture stool negative, Culture urine negative, Diarrhoea haemorrhagic, Gastrooesophageal reflux disease, Intussusception, Laparotomy, Lymphocyte count decreased, Monocyte count decreased, Nausea, Neutrophil count increased, Pyrexia, Small intestinal obstruction, Vomiting projectile, X-ray gastrointestinal tract abnormal
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction
CDC Split Type:

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.


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