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This is VAERS ID 416287

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

Case Details

VAERS ID: 416287 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Michigan  
Vaccinated:2010-11-16
Onset:2010-12-27
   Days after vaccination:41
Submitted: 2011-02-04
   Days after onset:39
Entered: 2011-02-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3713AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E72961 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB088A / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Appendicectomy, Diarrhoea, Enema administration, Explorative laparotomy, Haematochezia, Intussusception, Irritability, Mucous stools, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), 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 (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:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1101USA03592

Write-up: Information has been received from a physician concerning a 10 days old female patient who on 04-SEP-2010 was vaccinated with the first dose of PEDVAXHIB (manufacturer unknown) (Lot #, expire date and route not reported). On 16-NOV-2010, the patient was vaccinated with the second dose of PEDVAXHIB (manufacturer unknown) (Lot #, expire date and route not reported). Suspect vaccine included first dose of ROTARIX (Lot # A41FB088A, expire date and route not reported) administered on 04-SEP-2010 and second dose of ROTARIX (Lot # A41FB088A, expire date and route not reported) administered on 16-NOV-2010. Concomitant vaccines on 04-Sep-2010 (also reported as 07-Oct-2010) included PREVNAR. Physician reported that on 30-DEC-2010, patient was diagnosed with intussusception and was admitted to the hospital. The patient had surgery and the intussusception was reduced and the patient recovered. Physician added that had not seen the patient for a post-hospital follow up visit. This is one of two reports from the same source. Additional information has been requested.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=416287


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