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This is VAERS ID 528141

(NOTE: This result is from the 4/14/2014 version of the VAERS database)

Case Details

VAERS ID: 528141 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Oklahoma  
Vaccinated:2014-03-24
Onset:2014-03-29
   Days after vaccination:5
Submitted: 2014-04-10
   Days after onset:12
Entered: 2014-04-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 22J73 / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB405A / 0 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Barium enema abnormal, Intussusception
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal obstruction (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema
CDC Split Type:

Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20140414&IDNUMBER=528141


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