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This is VAERS ID 326995

Case Details

VAERS ID: 326995 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Michigan  
Vaccinated:2008-07-29
Onset:2008-09-22
   Days after vaccination:55
Submitted: 2008-10-03
   Days after onset:11
Entered: 2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC Split Type:

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


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