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This is VAERS ID 273982

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 273982 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Female  
Location: Colorado  
Vaccinated:2007-02-16
Onset:2007-03-10
   Days after vaccination:22
Submitted: 2007-03-14
   Days after onset:3
Entered: 2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Congenital, familial and genetic disorders (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ischaemic colitis (narrow), Hypoglycaemia (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC Split Type:

Write-up: Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


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