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This is VAERS ID 547231

Case Details

VAERS ID: 547231 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Male  
Location: Illinois  
Vaccinated:2014-07-18
Onset:2014-08-04
   Days after vaccination:17
Submitted: 2014-10-09
   Days after onset:66
Entered: 2014-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E4T92 / 1 - / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB406A / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Barium double contrast, Chest X-ray, Haematochezia, Intussusception, Irritability, Laboratory test, Ultrasound abdomen, Urinary system X-ray, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Hypoglycaemia (broad)

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:
Current Illness: None Known
Preexisting Conditions: None Known
Allergies:
Diagnostic Lab Data: KUB/CXR/lab/Ultrasound of abdomen
CDC Split Type:

Write-up: Hospitalized for bloody stool, emesis and irritability on 8/4/14. Trans to a second hospital on 8/5/14. IV fluids. Intussusception noted. Resolution with air contrast enema. Discharged on 8/6/14 feeding well and no further bloody stools.


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