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This is VAERS ID 292254

Case Details

VAERS ID: 292254 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: California  
Vaccinated:2007-02-02
Onset:2007-03-30
   Days after vaccination:56
Submitted: 2007-09-26
   Days after onset:180
Entered: 2007-10-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (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, 3 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.


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