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This is VAERS ID 292561

Case Details

VAERS ID: 292561 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: South Carolina  
Vaccinated:2007-10-02
Onset:2007-10-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Intussusception, Urinary system X-ray
SMQs:, Gastrointestinal obstruction (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix.IHC for adenovirus positive. IHC for Rotavirus A negative.
CDC Split Type:

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


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