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This is VAERS ID 319397

Case Details

VAERS ID: 319397 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:2008-04-08
Onset:2008-05-24
   Days after vaccination:46
Submitted: 2008-07-15
   Days after onset:52
Entered: 2008-07-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ischaemic colitis (broad), Hypoglycaemia (broad)

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
Allergies:
Diagnostic Lab Data: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC Split Type:

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.


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