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This is VAERS ID 275291

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

Case Details

VAERS ID: 275291 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Michigan  
Vaccinated:2007-01-15
Onset:2007-03-12
   Days after vaccination:56
Submitted: 2007-03-30
   Days after onset:18
Entered: 2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE972AA / - LA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08657F / - RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Barium enema, Crying, Enema administration, Faeces hard
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY
CDC Split Type:

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIA"BLE


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