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This is VAERS ID 285725

(NOTE: This result is from the 6/11/2011 version of the VAERS database)

Case Details

VAERS ID: 285725 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: Missouri  
Vaccinated:2007-07-03
Onset:2007-07-05
   Days after vaccination:2
Submitted: 2007-07-24
   Days after onset:19
Entered: 2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Blood glucose, Enema administration, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Ultrasound abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC Split Type:

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


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