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This is VAERS ID 258493

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

VAERS ID: 258493 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Virginia  
Vaccinated:2006-06-07
Onset:2006-06-13
   Days after vaccination:6
Submitted: 2006-06-16
   Days after onset:3
Entered: 2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES A98338B / - LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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 (narrow)

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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel.
CDC Split Type:

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception."Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=258493


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