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This is VAERS ID 457250

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 457250 (history)  
Form: Version .0  
Age: 0.18  
Gender: Female  
Location: Connecticut  
Vaccinated:2012-04-11
Onset:2012-06-01
   Days after vaccination:51
Submitted: 2012-06-05
   Days after onset:4
Entered: 2012-06-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4131AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC090FA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917245 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB210A / 0 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Barium enema, Barium enema abnormal, Intestinal obstruction, Intussusception, Surgery, X-ray abnormal
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: XRay barium enema confirming diagnosis
CDC Split Type:

Write-up: Intestinal obstruction -$g intussusception. Required surgery. Pt admitted to hospital.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=457250


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