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This is VAERS ID 273446

(NOTE: This result is from the 4/7/2010 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
DTAPHEPBIP: 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: Private
Symptoms: Abdominal X-ray, Abdominal pain, Barium enema, Blood albumin decreased, Blood sodium decreased, Constipation, Full blood count, Globulins decreased, Hepatomegaly, Intussusception, Laboratory test abnormal, Large intestinal obstruction reduction, Protein total decreased, Surgery, Ultrasound abdomen, Urine analysis, Urine ketone body present, Virus culture negative, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad)

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. Labs and Diagnostics: Abdominal/Pelvic x-ray showed a suggestion of hepatomegaly with displacement of bowel loops into the left abdomen. Abdominal US show (+) presence of extensive intussusception in the transve
CDC Split Type:

Write-up: Vomiting, constipated, abdominal pain. Treatment - surgery for intussusception. 04/16/2007 MR received for 2 night hospitalization 3/3-5/2007 for a 6 day h/o crampy abdominal pain, lack of bowel movement, and vomiting. Partial reduction of the intussusception was completed, however focal intussusception remained in the distal terminal ileum which was surgically reduced via open reduction. Discharge DX: Intussusception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=273446


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