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This is VAERS ID 333027

Case Details

VAERS ID: 333027 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Hawaii  
Vaccinated:2008-11-06
Onset:2008-11-11
   Days after vaccination:5
Submitted: 2008-11-21
   Days after onset:10
Entered: 2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 3 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, 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: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC Split Type:

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


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