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This is VAERS ID 314577

Case Details

VAERS ID: 314577 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: California  
Vaccinated:2008-05-22
Onset:2008-05-28
   Days after vaccination:6
Submitted: 2008-05-29
   Days after onset:1
Entered: 2008-06-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Intussusception, Lethargy, Mucous stools, Urinary system X-ray
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC Split Type:

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


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