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This is VAERS ID 274395

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

Case Details

VAERS ID: 274395 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: California  
Vaccinated:2007-01-17
Onset:2007-03-15
   Days after vaccination:57
Submitted: 2007-03-20
   Days after onset:5
Entered: 2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 836258A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan
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? Yes
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: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC Split Type:

Write-up: Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=274395


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