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This is VAERS ID 460202

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 460202 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: Rhode Island  
Vaccinated:2012-07-13
Onset:2012-07-13
   Days after vaccination:0
Submitted: 2012-07-18
   Days after onset:5
Entered: 2012-07-26
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1310AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema abnormal, Enema administration, Intussusception
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium enema with reduction
CDC Split Type:

Write-up: Intussusception.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=460202


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