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This is VAERS ID 278694

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 278694 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Michigan  
Vaccinated:2007-03-22
Onset:2007-05-06
   Days after vaccination:45
Submitted: 2007-05-08
   Days after onset:2
Entered: 2007-05-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC Split Type:

Write-up: Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=278694


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