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This is VAERS ID 319695

Case Details

VAERS ID: 319695 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Texas  
Vaccinated:2008-03-20
Onset:2008-05-23
   Days after vaccination:64
Submitted: 2008-07-18
   Days after onset:56
Entered: 2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 3 MO / PO

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

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 PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC Split Type:

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


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