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This is VAERS ID 288035

Case Details

VAERS ID: 288035 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: California  
Vaccinated:2007-07-09
Onset:2007-07-13
   Days after vaccination:4
Submitted: 2007-07-23
   Days after onset:10
Entered: 2007-08-14
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Intussusception, Surgery, X-ray
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC Split Type:

Write-up: Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


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