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This is VAERS ID 286241

Case Details

VAERS ID: 286241 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-01-22
Onset:2007-07-11
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2007-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC01B084CA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42260AA / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672K / 3 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Discomfort, Enema administration, Haematochezia, Intussusception, Surgery, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC Split Type:

Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.


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