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This is VAERS ID 457300

Case Details

VAERS ID: 457300 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Female  
Location: Texas  
Vaccinated:2012-06-05
Onset:2012-06-09
   Days after vaccination:4
Submitted: 2012-06-12
   Days after onset:3
Entered: 2012-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4047AB / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92471 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB273A / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Blood culture, CSF culture, Culture stool, Culture urine, Full blood count, Haematochezia, Intussusception, Laboratory test, Surgery, Urine analysis, Vomiting, X-ray
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC; CSF culture; Blood & stool cultures; X-rays; Chem; Urine culture; Urinalysis
CDC Split Type:

Write-up: Four days after vaccination, patient began vomiting, had bloody stools, diagnosed with intussusception, patient required surgery.


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