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This is VAERS ID 294236

Case Details

VAERS ID: 294236 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Massachusetts  
Vaccinated:2007-10-17
Onset:2007-10-17
   Days after vaccination:0
Submitted: 2007-10-22
   Days after onset:5
Entered: 2007-10-24
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Intussusception
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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC Split Type:

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.


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