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This is VAERS ID 303025

Case Details

VAERS ID: 303025 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Male  
Location: Texas  
Vaccinated:2007-11-13
Onset:2007-11-27
   Days after vaccination:14
Submitted: 2008-01-18
   Days after onset:52
Entered: 2008-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125BB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF193AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1168U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Enema administration, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Dermoid Cyst over R eye
Allergies:
Diagnostic Lab Data: Air contrast enema 2/5/08-records received-Incomplete reduction with air contrast enema. US positive for intussusception.
CDC Split Type:

Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.


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