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This is VAERS ID 289161

Case Details

VAERS ID: 289161 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Delaware  
Vaccinated:2007-07-24
Onset:2007-08-19
   Days after vaccination:26
Submitted: 2007-08-23
   Days after onset:4
Entered: 2007-08-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal pain, Barium enema, Chest X-ray, Intussusception, Small intestinal obstruction, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC Split Type:

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


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