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This is VAERS ID 299557

Case Details

VAERS ID: 299557 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: Washington  
Vaccinated:2007-11-21
Onset:2007-12-07
   Days after vaccination:16
Submitted: 2007-12-10
   Days after onset:3
Entered: 2007-12-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981H / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 3 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Barium double contrast, Enema administration, Haematochezia, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC Split Type:

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


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