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This is VAERS ID 273374

(NOTE: This result is from the 1/5/2010 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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private       Purchased by: Private
Symptoms: Computerised tomogram, Intussusception, Ultrasound scan, X-ray
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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, 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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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100105&IDNUMBER=273374


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