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This is VAERS ID 296290

Case Details

VAERS ID: 296290 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: New York  
Vaccinated:2007-10-31
Onset:2007-11-06
   Days after vaccination:6
Submitted: 2007-11-09
   Days after onset:3
Entered: 2007-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B194AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B50007A / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0876U / 2 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC Split Type:

Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.


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