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This is VAERS ID 351299

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 351299 (history)  
Form: Version 1.0  
Age: 0.58  
Gender: Female  
Location: South Carolina  
Vaccinated:2009-05-28
Onset:2009-06-15
   Days after vaccination:18
Submitted: 2009-07-07
   Days after onset:22
Entered: 2009-07-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 3 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 3 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
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: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC Split Type:

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=351299


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