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This is VAERS ID 461714

(NOTE: This result is from the 8/13/2012 version of the VAERS database)

Case Details

VAERS ID: 461714 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: New York  
Vaccinated:2012-07-25
Onset:2012-07-29
   Days after vaccination:4
Submitted: 2012-08-09
   Days after onset:11
Entered: 2012-08-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4257AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Enema administration, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Large intestinal obstruction reduction, Platelet count normal, Ultrasound abdomen, Vomiting, White blood cell count normal
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal x-ray; Abdominal Ultrasound; CBC: WBC 8.2; Hemoglobin 10.5; Hematocrit 31; Platelet count 436
CDC Split Type:

Write-up: 4 days after receiving immunization developed multiple episodes of vomiting becoming bilious went to ER and was discovered to have currant jelly stools. Tx: Air enema reduction of intussusception involving the sigmoid colon.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20120813&IDNUMBER=461714


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