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This is VAERS ID 298501

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 298501 (history)  
Form: Version .0  
Age: 0.18  
Gender: Female  
Location: Ohio  
Vaccinated:2007-09-18
Onset:2007-11-19
   Days after vaccination:62
Submitted: 2007-12-03
   Days after onset:14
Entered: 2007-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS PAC21B097AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF108AA / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0875U / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Computerised tomogram abnormal, Haematochezia, Intussusception, Laparoscopy, Mucous stools, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (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, 4 days
   Extended hospital stay? No
Previous Vaccinations: extreme crying, high pitched crying~DTaP + HepB + IPV (Pediarix)~1~0.20~Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: x-rays, CT scans, surgery 1/9/08-records received-CT abnormal. Barium enema unsuccessful attempt at reduction of intussusception at approximately the level of the distal ascending colon near the level of hepatic flexure.
CDC Split Type:

Write-up: 11/19/07 began with abd. pain and vomiting. taken to ER in Findlay in evening, discharged to home when vomiting ceased. symptoms continued that week and febrile suppositories given. on 11/24/07 taken to PCACC and xray, CT scan done. transferred to Hospital and had surgery for intusseption. 1/9/08-records received for DOS 11/24-11/28/07. DC DX: Intussusception. Laproscopic reduction of ileocolonic intussusception. Five days prior to admission developed abdominal pain and emesis. Bowel movement present with bloody mucus 2-3 days prior to admission.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=298501


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