This is VAERS ID 278694

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID:	278694 (history)
Form:	Version 1.0
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 / 2	RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0062U / 2	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08646C / 2	LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1235F / 3	MO / PO

Administered by: Private Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (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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