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This is VAERS ID 288350

Case Details

VAERS ID: 288350 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-07-11
Onset:2007-07-22
   Days after vaccination:11
Submitted: 2007-08-13
   Days after onset:22
Entered: 2007-08-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Intussusception, Occult blood positive, Surgery
SMQs:, Haemorrhage laboratory terms (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the terminal ileum. CBC with WBCs of 21.3 on admission. 14.9 by 7/25/07.
CDC Split Type:

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


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