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This is VAERS ID 344235

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 344235 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: New York  
Vaccinated:2009-03-31
Onset:2009-04-13
   Days after vaccination:13
Submitted: 2009-04-15
   Days after onset:2
Entered: 2009-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF513AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D33245 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal distension, Anal haemorrhage, Computerised tomogram abdomen abnormal, Enema administration, Exploratory operation, Intussusception, Lethargy, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hospitalized 2/13/09; RSV; Bronchiolitis
Allergies:
Diagnostic Lab Data: Abdominal series; UGI; air contrast enema; exploratory surgery 5/14/09 hospital discharge summary recieved DOA 4/9/09-4/13/09. LABS and DIAGNOSTICS: Abdominal x-ray - dilated small bowel loops. Air contrast enema. CT scan of abdomen/pe
CDC Split Type:

Write-up: Pt. received vaccine 3/31/09. Presented with vomiting, lethargy on 4/14/09. Required surgery for Intussusception. 5/14/09 hospital discharge summary recieved DOA 4/9/09-4/13/09. FINAL DIAGNOSIS: Intussusception Post vaccination emesis, abdominal distention, lethargic, blood clots around anus.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=344235


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