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This is VAERS ID 293579

Case Details

VAERS ID: 293579 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Arizona  
Vaccinated:2007-07-17
Onset:2007-10-15
   Days after vaccination:90
Submitted: 2007-10-18
   Days after onset:3
Entered: 2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 3 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB437AA / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF101AB / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Enema administration, Intussusception
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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol infant drops
Current Illness: None
Preexisting Conditions: Plagiocephaly and mild gastroesophegeal reflux
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US c/w IS. BE c/w ileocolic IS. Air contrast enema successfully reduced IS. WBC 21.3, H/H 11.4/32.9, segs 54, lymphs 37, monos 6. Chemistry WNL. UA WNL. Blood culture done.
CDC Split Type:

Write-up: Intussception at 9 months. 12/7/07 Reviewed hospital medical records which reveal patient experienced crampy abdominal pain, irritability, vomiting. Was on antibiotics for otitis media. Surgery consult done. Admitted 10/15-10/16/2007 for observation s/p enema reduction of IS. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


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