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This is VAERS ID 286077

Case Details

VAERS ID: 286077 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Texas  
Vaccinated:2007-04-05
Onset:2007-05-21
   Days after vaccination:46
Submitted: 2007-07-26
   Days after onset:66
Entered: 2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 1 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 8362584 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Barium double contrast, Barium enema, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC Split Type:

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


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