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This is VAERS ID 307215

Case Details

VAERS ID: 307215 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:2008-01-15
Onset:2008-01-29
   Days after vaccination:14
Submitted: 2008-03-12
   Days after onset:42
Entered: 2008-03-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Constipation, Intussusception, Ultrasound scan
SMQs:, 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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed rectosigmoid ratio noted. Ultrasound spine normal. Supine abdominal fil no signs of obstruction or free area.
CDC Split Type:

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


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