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This is VAERS ID 275949

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

Case Details

VAERS ID: 275949 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Indiana  
Vaccinated:2007-02-16
Onset:2007-04-09
   Days after vaccination:52
Submitted: 2007-04-10
   Days after onset:1
Entered: 2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1016F / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Barium double contrast, Colostomy, Diarrhoea haemorrhagic, Gastrointestinal necrosis, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon.
CDC Split Type:

Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=275949


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