This is VAERS ID 403352

(NOTE: This result is from the 5/13/2011 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, 6 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=20110513&IDNUMBER=403352