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This is VAERS ID 435498

(NOTE: This result is from the 10/11/2011 version of the VAERS database)

Case Details

VAERS ID: 435498 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: New York  
Vaccinated:2011-07-06
Onset:2011-08-18
   Days after vaccination:43
Submitted: 2011-09-24
   Days after onset:37
Entered: 2011-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1515J / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E63641 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS 102A / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception, Surgery, Vitello-intestinal duct remnant, Vomiting
SMQs:, Acute pancreatitis (broad), Congenital, familial and genetic disorders (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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, 10 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Patient had Meckels diverticulum. Intussusception in small bowel.
CDC Split Type:

Write-up: Vomiting after every feeding for 2 days. Vomiting even without any liquids or feedings. Baby was hospitalize with an IV and the intussusception was found once she started vomiting bios and they did an internal exam. She had emergency surgery 30 hours after first symptoms.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20111011&IDNUMBER=435498


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