National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 290330

Case Details

VAERS ID: 290330 (history)  
Form: Version 1.0  
Age: 0.1  
Gender: Male  
Location: California  
Vaccinated:2007-05-26
Onset:2007-07-15
   Days after vaccination:50
Submitted: 2007-09-05
   Days after onset:52
Entered: 2007-09-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B074AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF022AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 1 MO / PO

Administered by: Other       Purchased by: Other
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? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: Enema unsuccessful x several attempts.
CDC Split Type:

Write-up: July 2007, intussusception S/P repair. 9/18/07 Reviewed vax record from provider which confirms RO dose & lot # as reported. 9/17/07 Reviewed hospital medical records which reveal patient experienced vomiting. Seen in ER 7/15/07 & d/c to home. Continued w/vomiting, abdominal pain & developed dark stools. Admitted 7/16-7/19/2007. Failed hydrostatic reduction & taken to OR for reduction & appy. Progressed well & d/c to home. FINAL DX: Ileocecal intussusception w/lead point in midtransverse colon; appendectomy.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=290330


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