This is VAERS ID 274395

(NOTE: This result is from the 3/2/2010 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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B079BA / 0	LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0784F / 0	RL / IM
PNC: PNEUMO (PREVNAR7) / 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=20100302&IDNUMBER=274395