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This is VAERS ID 288297

Case Details

VAERS ID: 288297 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: New York  
Vaccinated:2007-07-27
Onset:2007-08-09
   Days after vaccination:13
Submitted: 2007-08-16
   Days after onset:7
Entered: 2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086908 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Crying, Enema administration, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Platelet count normal, White blood cell count increased
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray revealed IS. Barium enema w/air contrast
CDC Split Type:

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


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