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This is VAERS ID 291515

Case Details

VAERS ID: 291515 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: Maryland  
Vaccinated:2007-03-06
Onset:2007-09-20
   Days after vaccination:198
Submitted: 2007-09-27
   Days after onset:7
Entered: 2007-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B0B4BA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 04084F / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684F / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Enema administration, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (narrow)

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: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC Split Type:

Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


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