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This is VAERS ID 268404

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

Case Details

VAERS ID: 268404 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Kansas  
Vaccinated:2006-10-02
Onset:2006-12-04
   Days after vaccination:63
Submitted: 2006-12-05
   Days after onset:1
Entered: 2006-12-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Small intestinal intussusception reduction, Ultrasound abdomen abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC Split Type:

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=268404


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