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This is VAERS ID 316652

Case Details

VAERS ID: 316652 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:2008-03-27
Onset:2008-04-30
   Days after vaccination:34
Submitted: 2008-06-19
   Days after onset:50
Entered: 2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (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, 3 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC Split Type:

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


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