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This is VAERS ID 507498

Case Details

VAERS ID: 507498 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Female  
Location: Ohio  
Vaccinated:2013-09-30
Onset:2013-10-05
   Days after vaccination:5
Submitted: 2013-10-14
   Days after onset:9
Entered: 2013-10-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH826AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB346A / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Enema administration, Grunting, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Platelet count normal, Ultrasound abdomen abnormal, Urinary system X-ray, Vomiting, White blood cell count normal
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 15.2; Hgb 11.1; HCT 34.3; Plt 468; KUB; Abd. ultrasound confirmed intussusception
CDC Split Type:

Write-up: 10/5/13 ER with vomiting and grunting, pulling up legs. Abd. films negative - discharged home. 10/7/13 Presented to ER with vomiting and bloody stool. 10/7/13 - Dx: ileocolic intussusception. Tx: air enema.


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