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This is VAERS ID 383903

(NOTE: This result is from the 6/11/2011 version of the VAERS database)

Case Details

VAERS ID: 383903 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-03-18
Onset:2010-03-25
   Days after vaccination:7
Submitted: 2010-03-29
   Days after onset:4
Entered: 2010-03-31
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal distension, Abdominal operation, Diarrhoea, Enema administration, Intestinal mass, Intussusception, Laparotomy, Pathology test, Platelet count increased, Ultrasound abdomen abnormal, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110611&IDNUMBER=383903


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