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This is VAERS ID 317989

Case Details

VAERS ID: 317989 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: D.C.  
Vaccinated:2008-03-04
Onset:2008-05-08
   Days after vaccination:65
Submitted: 2008-06-27
   Days after onset:50
Entered: 2008-07-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Barium double contrast, 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC Split Type:

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


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