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This is VAERS ID 432001

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 432001 (history)  
Form: Version .0  
Age: 0.34  
Gender: Female  
Location: Wisconsin  
Vaccinated:2011-08-09
Onset:2011-08-21
   Days after vaccination:12
Submitted: 2011-08-23
   Days after onset:2
Entered: 2011-08-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300CA / 1 RL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0487AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915347 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB203A / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Enema administration, Haematochezia, Intussusception, Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypoglycaemia (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema dx''d intussusception
CDC Split Type:

Write-up: ROTARIX #2 given 8/9/11. 1 currant jelly stool, severe lethargy, crampy abd pain, bile emesis. Intussusception occurred 8/21/11. Radiology reduced partially 8/21. Radiology reduced fully 8/22.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=432001


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