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This is VAERS ID 323866

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 323866 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: New Jersey  
Vaccinated:2008-08-05
Onset:2008-08-22
   Days after vaccination:17
Submitted: 2008-08-26
   Days after onset:4
Entered: 2008-09-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 3 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haematochezia, Intussusception, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnormal-hemolyzed spec.
CDC Split Type:

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


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