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This is VAERS ID 378219

(NOTE: This result is from the 5/13/2011 version of the VAERS database)

Case Details

VAERS ID: 378219 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Alabama  
Vaccinated:2009-10-15
Onset:2010-01-01
   Days after vaccination:78
Submitted: 2010-01-19
   Days after onset:18
Entered: 2010-01-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Enema administration, Intestinal resection, Intussusception, Laparoscopic surgery, Lethargy, Vomiting, X-ray
SMQs:, Acute pancreatitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC Split Type:

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110513&IDNUMBER=378219


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