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This is VAERS ID 268404

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 268404 (history)  
Form: Version .0  
Age: 0.17  
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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Enema administration, Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Ultrasound abdomen abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), 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:
Current Illness: None
Preexisting Conditions: None
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. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=268404


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