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This is VAERS ID 299088

Case Details

VAERS ID: 299088 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Florida  
Vaccinated:2007-10-01
Onset:2007-12-01
   Days after vaccination:61
Submitted: 2007-12-04
   Days after onset:3
Entered: 2007-12-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Computerised tomogram abnormal, Haematochezia, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

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: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC Split Type:

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


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