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This is VAERS ID 414363

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

Case Details

VAERS ID: 414363 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Maryland  
Vaccinated:2010-12-09
Onset:2010-12-26
   Days after vaccination:17
Submitted: 2011-01-06
   Days after onset:11
Entered: 2011-01-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B254BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E804460 / 0 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB104A / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Anion gap increased, Barium enema abnormal, Blood creatinine decreased, Blood glucose increased, Blood potassium increased, Blood sodium decreased, Carbon dioxide decreased, Crying, Decreased activity, Enema administration, Food intolerance, Gastrointestinal haemorrhage, Gastrointestinal sounds abnormal, Gram stain positive, Haematochezia, Intussusception, Leukocytosis, Lymphocyte count increased, Lymphocyte percentage increased, Macrocytosis, Mean cell volume increased, Occult blood positive, Platelet count increased, Ultrasound abdomen abnormal, Ultrasound scan, White blood cell count increased, X-ray, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was on Nutramifen before for milk intolerance
Allergies:
Diagnostic Lab Data: Diagnostic ultrasound and fluoroscopy
CDC Split Type:

Write-up: Pt. had bloody stools 17 days after receiving ROTARIX, dx with intussusception. Went to hospital 12/31/10. Dx with formula intolerance - on ELECORE.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=414363


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