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This is VAERS ID 381719

Case Details

VAERS ID: 381719 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Virginia  
Vaccinated:2010-02-22
Onset:2010-02-27
   Days after vaccination:5
Submitted: 2010-03-02
   Days after onset:3
Entered: 2010-03-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Haematochezia, Intussusception, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC Split Type:

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


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