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This is VAERS ID 294451

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 294451 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Virginia  
Vaccinated:2007-09-12
Onset:2007-10-21
   Days after vaccination:39
Submitted: 2007-10-22
   Days after onset:1
Entered: 2007-10-25
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Appendicectomy, Enema administration, Haematochezia, Intussusception, Monocyte percentage increased, Platelet count increased, Surgery, Vomiting, White blood cell count increased, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

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: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC Split Type:

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=294451


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