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This is VAERS ID 323278

Case Details

VAERS ID: 323278 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Florida  
Vaccinated:2008-06-17
Onset:2008-08-06
   Days after vaccination:50
Submitted: 2008-08-20
   Days after onset:14
Entered: 2008-08-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC Split Type:

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


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