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This is VAERS ID 289427

Case Details

VAERS ID: 289427 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: California  
Vaccinated:2007-07-27
Onset:2007-08-18
   Days after vaccination:22
Submitted: 2007-08-30
   Days after onset:12
Entered: 2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~1~0.40~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC Split Type:

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


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