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This is VAERS ID 289592

Case Details

VAERS ID: 289592 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Virginia  
Vaccinated:2007-07-13
Onset:2007-08-13
   Days after vaccination:31
Submitted: 2007-08-20
   Days after onset:7
Entered: 2007-08-31
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681K / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Barium double contrast, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC Split Type:

Write-up: 4 mo with intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


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