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This is VAERS ID 311843

Case Details

VAERS ID: 311843 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Tennessee  
Vaccinated:2008-04-04
Onset:2008-04-23
   Days after vaccination:19
Submitted: 2008-05-05
   Days after onset:12
Entered: 2008-05-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Intussusception, Urinary system X-ray
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes decreased 35, blood culture no growth.
CDC Split Type:

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


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