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This is VAERS ID 523871

(NOTE: This result is from the 3/14/2015 version of the VAERS database)

Case Details

VAERS ID: 523871 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Louisiana  
Vaccinated:2014-02-18
Onset:2014-02-21
   Days after vaccination:3
Submitted: 2014-02-24
   Days after onset:3
Entered: 2014-02-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J011112 / - LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G98915 / - LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB389A / - - / PO

Administered by: Private       Purchased by: Public
Symptoms: Enema administration, Haematochezia, Intussusception, Mental status changes, Urinary system X-ray, X-ray abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Cardiomyopathy (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hytone PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC Split Type:

Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20150314&IDNUMBER=523871


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