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This is VAERS ID 271803

(NOTE: This result is from the 6/11/2011 version of the VAERS database)

Case Details

VAERS ID: 271803 (history)  
Form: Version .0  
Age: 0.6  
Gender: Female  
Location: Connecticut  
Vaccinated:2006-12-08
Onset:2007-01-26
   Days after vaccination:49
Submitted: 2007-01-31
   Days after onset:5
Entered: 2007-02-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal X-ray, Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
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: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC Split Type:

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110611&IDNUMBER=271803


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