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This is VAERS ID 272809

(NOTE: This result is from the 5/13/2011 version of the VAERS database)

Case Details

VAERS ID: 272809 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Illinois  
Vaccinated:2007-01-12
Onset:2007-02-15
   Days after vaccination:34
Submitted: 2007-02-21
   Days after onset:6
Entered: 2007-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 0 - / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0785F / 0 - / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 0 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Barium enema, Crying, Diarrhoea, Intussusception
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: lower GI-showed intussusception and resolved the problem LABS: water soluble contrast lower GI enema successful in reducing ileocecal IS.
CDC Split Type:

Write-up: Had an intussusception reduced by barium enema on 2/16/07-Ileocal intussusception pain began on 2/15/07. 3/1/07 Received medical records from hospital which reveal patient experienced uncontrollable crying & diarrhea for 2 days along with apparent abdominal pain intermittently for several hours prior to ER. Exam revealed abdomen distended & tender. Patient d/c home same day as successful IS reduction to be f/u by PCP.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110513&IDNUMBER=272809


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