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This is VAERS ID 355481

(NOTE: This result is from the 3/14/2015 version of the VAERS database)

Case Details

VAERS ID: 355481 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Tennessee  
Vaccinated:2009-08-20
Onset:2009-08-24
   Days after vaccination:4
Submitted: 2009-08-26
   Days after onset:2
Entered: 2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal distension, Barium double contrast, Culture stool, Enema administration, Full blood count normal, Gastrointestinal sounds abnormal, Haematochezia, Intussusception, Metabolic function test normal, Occult blood positive, Pyrexia, Stool analysis, Surgery, Ultrasound abdomen abnormal, Urinary system X-ray, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC Split Type:

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20150314&IDNUMBER=355481


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