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This is VAERS ID 456491

Case Details

VAERS ID: 456491 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Female  
Location: Tennessee  
Vaccinated:2012-02-28
Onset:2012-03-22
   Days after vaccination:23
Submitted: 2012-05-30
   Days after onset:69
Entered: 2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315DA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1189AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F22722 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41B226A / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Crying, Culture stool, Full blood count, Haematochezia, Intussusception, Metabolic function test, Occult blood, X-ray
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC Split Type:

Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult.


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