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This is VAERS ID 416354

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

Case Details

VAERS ID: 416354 (history)  
Form: Version .0  
Age: 0.6  
Gender: Female  
Location: Michigan  
Vaccinated:2010-10-22
Onset:2011-01-03
   Days after vaccination:73
Submitted: 2011-02-07
   Days after onset:35
Entered: 2011-02-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B250BA / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1486Y / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E70436 / 1 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB098A / 2 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Abnormal faeces, Barium double contrast abnormal, Barium enema, Blood albumin decreased, Blood calcium increased, Blood iron decreased, Blood potassium increased, Chest X-ray abnormal, Diarrhoea, Ear infection, Enema administration, Failure to thrive, Haematochezia, Intussusception, Irritability, Platelet count increased, Protein total increased, Pyrexia, Small intestinal intussusception reduction, Ultrasound abdomen abnormal, Urine ketone body present, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Neonatal disorders (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1101USA03537

Write-up: Information has been received from a physician concerning a 7 month old female patient who on 11-MAY-2010 was vaccinated with the first dose of ROTATEQ (Lot # 665273/0204Z, expire date not reported), per oral. On 31-AUG-2010, the patient was vaccinated with the second dose of ROTATEQ (Lot # 667991/0726Z, expire date not reported), per oral. Suspect secondary therapy included third dose of ROTARIX (Lot # A41FB098A, expire date and route not reported) administered on 22-OCT-2010, first dose of Hib conj vaccine (manufacturer unknown) and first dose of hepatitis B vaccine (manufacturer unknown) both administered on 11-MAY-2010, second dose of Hib conj vaccine administered on 31-AUG-2010, second dose of hepatitis B vaccine (manufacturer unknown) and third dose of Hib conj vaccine both administered on 22-OCT-2010. Concomitant vaccines included DTAP, poliovirus vaccine and PREVNAR. Physician stated that on 03-JAN-2011, the patient was admitted to the hospital and was diagnosed with intussusception. Physician added that a barium enema was successful in releasing the intussusception. The patient recovered and on 06-JAN-2011, the patient was discharged from the hospital. This is one of two reports from the same source. Additional information has been requested.


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