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This is VAERS ID 444118

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 444118 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Female  
Location: Maryland  
Vaccinated:2011-10-24
Onset:2011-10-31
   Days after vaccination:7
Submitted: 2011-11-14
   Days after onset:14
Entered: 2011-11-30
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305AA / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F08531 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB2269 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Concern of increased spit up.
Allergies:
Diagnostic Lab Data: Intussusception.
CDC Split Type:

Write-up: Went to ER with severe vomiting. Ultrasound found intussusception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=444118


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