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This is VAERS ID 284308

(NOTE: This result is from the 5/14/2017 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
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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. Gastroesophageal reflux disease. CT abdomen: Small bowel obstruction presumably due to ileoileal or ileocecal intussusception in distal ileum
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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