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This is VAERS ID 334086

Case Details

VAERS ID: 334086 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: Illinois  
Vaccinated:2008-11-28
Onset:2008-12-03
   Days after vaccination:5
Submitted: 2008-12-05
   Days after onset:2
Entered: 2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Enema administration, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC Split Type:

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


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