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This is VAERS ID 403352

(NOTE: This result is from the 11/3/2010 version of the VAERS database)

Case Details

VAERS ID: 403352 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Missouri  
Vaccinated:2010-08-10
Onset:2010-08-31
   Days after vaccination:21
Submitted: 2010-10-14
   Days after onset:44
Entered: 2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Abdominal distension, Colectomy, Ileectomy, Intussusception, Surgery, Ultrasound scan abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), 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? No
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: had ultrasound and then surgery
CDC Split Type:

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20101103&IDNUMBER=403352


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