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This is VAERS ID 285152

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 285152 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: California  
Vaccinated:2007-05-30
Onset:2007-07-03
   Days after vaccination:34
Submitted: 2007-07-18
   Days after onset:15
Entered: 2007-07-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B07AA / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 784F / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086665 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 1 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Dehydration, Fontanelle depressed, Intussusception
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Neonatal disorders (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07
CDC Split Type:

Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecif"ied) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient reco


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