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This is VAERS ID 306984

Case Details

VAERS ID: 306984 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Georgia  
Vaccinated:2007-11-20
Onset:2008-02-02
   Days after vaccination:74
Submitted: 2008-03-10
   Days after onset:36
Entered: 2008-03-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125BA / 3 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF211AA / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007H / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 13934 / 3 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topicort 0.05%
Current Illness:
Preexisting Conditions: Atopic Dermatitis 3/14/08-records received-PMH: allergies to wheat, egg and cat dander. Develops rash with wheat.
Allergies:
Diagnostic Lab Data: Air contrast enema 2/2/08 3/14/08-records received-CT head unremarkable. Abdominal CT revealed probable ileocolic intussusception, air contrast enema with successful reduction. Blood gas 7.26 ph, CO2 40. Hgb 9.8.
CDC Split Type:

Write-up: He was diagnosed with intussusception 2/2/08 with respiratory failure. Intussusception relieved via air contrast and reduction. 3/14/08-DC summary received for DOS 2/2/08- 2/5/08-DX Inutssusception. Afternoon of admission became fussy, refused to eat and developed pale lips. Intubated. Respiratory failure secondary to intussusception. Extubated with stridor improved to room air.


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