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This is VAERS ID 384954

Case Details

VAERS ID: 384954 (history)  
Form: Version 1.0  
Age: 0.21  
Sex: Male  
Location: Nebraska  
   Days after vaccination:4
Submitted: 2010-04-12
   Days after onset:0
Entered: 2010-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Private
Symptoms: Abnormal faeces, Decreased appetite, Diarrhoea haemorrhagic, Intussusception, Irritability, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid.
Current Illness: No.
Preexisting Conditions: None.
Diagnostic Lab Data: Barium enema was both diagnostic of and therapeutic for the intussusception.
CDC Split Type:

Write-up: Poor appetite began after 9 PM feeding on 4/11. She became more sleepy and irritable. Emesis began in the AM on 4/12 with a large foul smeling stool. She was initially seen in the office. However, the emesis evolved into bloody diarrhea. She was then seen in the Hospital and Medical Center ED and was diagnosed with an intussusception.

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