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This is VAERS ID 316703

Case Details

VAERS ID: 316703 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New York  
Vaccinated:2008-05-19
Onset:2008-06-10
   Days after vaccination:22
Submitted: 2008-06-16
   Days after onset:6
Entered: 2008-06-20
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Enema administration, Intussusception
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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC Split Type:

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


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