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This is VAERS ID 272130

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 272130 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Michigan  
Vaccinated:2007-02-07
Onset:2007-02-10
   Days after vaccination:3
Submitted: 2007-02-12
   Days after onset:2
Entered: 2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Culture urine negative, Diverticular hernia, Enema administration, Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussus
CDC Split Type:

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=272130


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