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This is VAERS ID 416084

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

Case Details

VAERS ID: 416084 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Virginia  
Vaccinated:2011-01-20
Onset:2011-01-24
   Days after vaccination:4
Submitted: 2011-02-02
   Days after onset:9
Entered: 2011-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB025A / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Basophil percentage increased, Blood calcium decreased, Blood chloride increased, Blood culture positive, Blood potassium decreased, Crying, Decreased activity, Decreased appetite, Diarrhoea, Explorative laparotomy, Gastric occult blood positive, Gram stain positive, Haematochezia, Haematocrit decreased, Hypersomnia, Intussusception, Lethargy, Melaena, Mental status changes, Monocyte percentage increased, Neutrophil percentage decreased, Opisthotonus, Platelet count increased, Pyrexia, Staring, Surgery, Tachycardia, Unresponsive to stimuli, Vomiting, White blood cell count decreased, X-ray abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA; Born 35 weeks; tx''d w/ antibiotics to r/o sepsis; Rapid heart rate
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: GM states baby became ill 1/24/11 with vom., diarrhea, lethargy, etc. Took to ER then transferred to another hospital. Admitted. Underwent bowel surgery for intussusception.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=416084


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