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This is VAERS ID 446483

(NOTE: This result is from the 6/14/2014 version of the VAERS database)

Case Details

VAERS ID: 446483 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Iowa  
Vaccinated:2011-12-14
Onset:2011-12-27
   Days after vaccination:13
Submitted: 2011-12-29
   Days after onset:2
Entered: 2011-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4000AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916974 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB199A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Haematemesis, Haematochezia, Intussusception, Somnolence
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 5-month-old female admitted via the emergency room for hematemesis, hematochezia and increased sleep. Symptoms began a few days prior to admission, when they just noticed that she was sleeping a lot more than usual. She had been exposed to her maternal grandfather, who had been sick with some sort of illness, mom was not sure. Two days prior to admission, she started having a few diarrheal stools and, on the day of admission, apparently had some blood in her diaper. She was brought to the emergency room and they thought they might have seen some blood in her emesis and, based on age and hematemesis and hematochezia, the decision was made for observation and treatment in the hospital. Final dx: Intussusception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20140614&IDNUMBER=446483


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