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This is VAERS ID 315578

Case Details

VAERS ID: 315578 (history)  
Form: Version 1.0  
Age: 0.51  
Sex: Male  
Location: Illinois  
Vaccinated:2007-10-22
Onset:2008-04-08
   Days after vaccination:169
Submitted: 2008-05-02
   Days after onset:24
Entered: 2008-06-09
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Fluid intake reduced, Intussusception, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Dehydration (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC Split Type:

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


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