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This is VAERS ID 433714

(NOTE: This result is from the 9/14/2011 version of the VAERS database)

Case Details

VAERS ID: 433714 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-07-25
Onset:2011-07-29
   Days after vaccination:4
Submitted: 2011-09-07
   Days after onset:40
Entered: 2011-09-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B300AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916044 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Intestinal operation, Intussusception
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BE & Surgical repair
CDC Split Type:

Write-up: Pt developed intussusception 4 days after vaccines including ROTARIX.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110914&IDNUMBER=433714


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