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This is VAERS ID 382236

Case Details

VAERS ID: 382236 (history)  
Form: Version 1.0  
Age: 0.42  
Sex: Female  
Location: Unknown  
Vaccinated:2010-03-02
Onset:2010-03-05
   Days after vaccination:3
Submitted: 2010-03-09
   Days after onset:4
Entered: 2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C13802 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1211Y / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intestinal resection, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Ultrasound on 3/8 with intussusception, surgery on 3/8/2010 for intussusception with bowel rupture at Hospital
CDC Split Type:

Write-up: Patient developed intussusception with vomiting starting 3/5/2010 and requiring surgery for intussusception with bowel resection on 3/8/2010


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