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This is VAERS ID 360569

(NOTE: This result is from the 4/14/2017 version of the VAERS database)

Case Details

VAERS ID: 360569 (history)  
Form: Version .0  
Age: 0.17  
Gender: Female  
Location: Michigan  
Vaccinated:2009-09-28
Onset:2009-10-06
   Days after vaccination:8
Submitted: 2009-10-17
   Days after onset:11
Entered: 2009-10-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC Split Type:

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170414&IDNUMBER=360569


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