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This is VAERS ID 421972

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 421972 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: California  
Vaccinated:2011-04-04
Onset:2011-04-08
   Days after vaccination:4
Submitted: 2011-04-29
   Days after onset:21
Entered: 2011-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH254AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915572 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB094A / 0 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Barium double contrast, Enema administration, Intussusception, Surgery, Ultrasound abdomen
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: U/S abdomen; Air contrast enema
CDC Split Type:

Write-up: 4 days after receiving delays 2 mo vaccines, including ROTARIX, pt developed intussusception that needed to be surgically reduced. (DTap-HBV-POL, HIB, PCV 13, ROT 1).


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=421972


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