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This is VAERS ID 314724

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 314724 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: New Hampshire  
Vaccinated:2008-04-29
Onset:2008-05-12
   Days after vaccination:13
Submitted: 2008-05-23
   Days after onset:11
Entered: 2008-06-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown       Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Enema administration, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Oral intake reduced, Ultrasound abdomen abnormal, Urinary system X-ray, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC Split Type:

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100302&IDNUMBER=314724


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