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This is VAERS ID 273446

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

Case Details

VAERS ID: 273446 (history)  
Form: Version .0  
Age: 0.5  
Gender: Female  
Location: Michigan  
Vaccinated:2007-01-15
Onset:2007-02-26
   Days after vaccination:42
Submitted: 2007-03-05
   Days after onset:7
Entered: 2007-03-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC218092AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1015F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / - - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal pain, Barium enema, Blood albumin decreased, Blood sodium decreased
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abd X ray and US of abd.
CDC Split Type:

Write-up: Vomiting, constipated, abdominal pain. Treatment - surgery for intussusception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=273446


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