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This is VAERS ID 453732

(NOTE: This result is from the 3/14/2015 version of the VAERS database)

Case Details

VAERS ID: 453732 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Missouri  
Vaccinated:2012-03-22
Onset:2012-04-09
   Days after vaccination:18
Submitted: 2012-04-16
   Days after onset:7
Entered: 2012-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1310AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917243 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41P024DA / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Enema administration, Intestinal perforation, Intussusception, Ultrasound abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow), 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, 36 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None at time of vaccination
Current Illness: None
Preexisting Conditions: Bilateral club feet; hyperbilirubinemia after birth (resolved)
Allergies:
Diagnostic Lab Data: 4/10/12 Ultrasound abdomen: right upper quadrant intussusception, likely ileocolic
CDC Split Type:

Write-up: Ileocolic intussusception with perforation after attempted reduction via air enema. Intussusception occurred 18.5 days after vaccination.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20150314&IDNUMBER=453732


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