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This is VAERS ID 273374

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

Case Details

VAERS ID: 273374 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Arizona  
Vaccinated:2007-01-16
Onset:2007-02-19
   Days after vaccination:34
Submitted: 2007-03-05
   Days after onset:14
Entered: 2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT hea
CDC Split Type:

Write-up: Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


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