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This is VAERS ID 300429

Case Details

VAERS ID: 300429 (history)  
Form: Version 1.0  
Age: 0.51  
Gender: Male  
Location: Virginia  
Vaccinated:2007-12-04
Onset:2007-12-18
   Days after vaccination:14
Submitted: 2007-12-19
   Days after onset:1
Entered: 2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2749AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2456EA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0169 / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540168 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942U / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, X-ray abnormal
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Two view abdominal showed dilated loops of small bowel: obstruction 1/9/08-records received-Barium enema incomplete reduction. Upper GI confirms limited ultrasound report, no malrotation, free fluid, favoring intussusception right midabdomen. 1/12/08-received tissue samples from this patient. Results: The sample was positive for adenovirus and negative for rotavirus.
CDC Split Type:

Write-up: 12-18-07 intussception - having surgery 12-19-07 1/9/08-records received for DOS 12/18-12/22/07-DC DX: Intussusception. Exploratory laparotomy and reduction of intussusception not reduced by 2 hydrostatic enemas. Day prior to admission vomting and decrease urine. No bowel movement for 2 days.


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