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This is VAERS ID 306766

Case Details

VAERS ID: 306766 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: New York  
Vaccinated:2008-03-04
Onset:2008-03-06
   Days after vaccination:2
Submitted: 2008-03-10
   Days after onset:3
Entered: 2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Enema administration, Intussusception, Irritability, Melaena, Pain, Surgery, X-ray abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC Split Type:

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


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