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This is VAERS ID 279032

(NOTE: This result is from the 4/13/2011 version of the VAERS database)

Case Details

VAERS ID: 279032 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Kentucky  
Vaccinated:2006-11-07
Onset:2006-11-13
   Days after vaccination:6
Submitted: 2007-05-16
   Days after onset:183
Entered: 2007-05-18
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Barium double contrast, Decreased appetite, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC Split Type:

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=279032


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