National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 393611

(NOTE: This result is from the 4/13/2011 version of the VAERS database)

Case Details

VAERS ID: 393611 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Colorado  
Vaccinated:2010-07-14
Onset:2010-07-20
   Days after vaccination:6
Submitted: 2010-07-26
   Days after onset:6
Entered: 2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Antibiotic resistant Staphylococcus test negative, Barium enema, Barium enema abnormal, Biopsy intestine abnormal, Computerised tomogram abnormal, Crying, Diarrhoea haemorrhagic, Enema administration, Haematochezia, Ileectomy, Intestinal infarction, Intestinal polyp, Intussusception, Irritability, Laparoscopic surgery, Mucous stools, Small intestinal anastomosis, Small intestinal intussusception reduction, Urinary system X-ray, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal premalignant disorders (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (narrow), Depression (excl suicide and self injury) (broad)

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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=393611


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166