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This is VAERS ID 285152

(NOTE: This result is from the 8/31/2010 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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B07AA / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 784F / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086665 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Dehydration, Fontanelle depressed, Intussusception, Laparotomy, Surgery, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic 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 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC Split Type: WAES0707USA02148

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 (unspecified) 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 recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy


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