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This is VAERS ID 302822

Case Details

VAERS ID: 302822 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Florida  
Vaccinated:2007-11-12
Onset:2007-12-18
   Days after vaccination:36
Submitted: 2008-01-15
   Days after onset:28
Entered: 2008-01-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143C / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Appendicectomy, Barium enema, Biopsy lymph gland, Intussusception, Surgery, Ultrasound scan, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blood cx (-).
CDC Split Type:

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


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