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This is VAERS ID 462749

Case Details

VAERS ID: 462749 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Female  
Location: Connecticut  
Vaccinated:2012-08-07
Onset:2012-08-12
   Days after vaccination:5
Submitted: 2012-08-14
   Days after onset:2
Entered: 2012-08-22
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C419AA / 1 RL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB268A / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema abnormal, Enema administration, Haematochezia, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intussusception diagnosed at hospital 8/12/12. Reduced by barium enema at hospital. S/p vomiting & bloody stools.


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