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This is VAERS ID 483887

(NOTE: This result is from the 2/13/2013 version of the VAERS database)

Case Details

VAERS ID: 483887 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: California  
Vaccinated:2013-02-08
Onset:2013-02-08
   Days after vaccination:0
Submitted: 2013-02-10
   Days after onset:2
Entered: 2013-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B377AA / 0 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UH691AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB314A / - - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal distension, Intussusception, Irritability, Somnolence, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)

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

Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130213&IDNUMBER=483887


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