National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 286500

Case Details

VAERS ID: 286500 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Virginia  
Vaccinated:2007-06-01
Onset:2007-06-17
   Days after vaccination:16
Submitted: 2007-07-31
   Days after onset:44
Entered: 2007-08-02
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC148056BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF100AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO869OC / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception, Surgery
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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: BE unsuccessful. Abdominal x-ray revealed probable IS. Urine, blood, stool c/s neg. Stool for rotavirus neg.
CDC Split Type:

Write-up: Infant received ROTATEQ 2nd dose on 6/1/07; on 6/17/07diagnosed and operated on for intussusception in hospital. 8/3/07 Received vax record which provided RO lot # 1365F & dose #2. Prevnar Lot # should be B08690C. Database updated w/same. 8/28/07 Received hospital medical records from CDC which reveal patient experienced vomiting & bloody stool x 1 day. Admitted 6/17-6/19/07. BE diagnosed IS but unable to reduce. To OR for reduction of ileocolic IS & appendectomy. Progressed well post op. FINAL DX: Ileocolic IS, surgical reduction.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=286500


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166