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This is VAERS ID 544001

(NOTE: This result is from the 10/14/2014 version of the VAERS database)

Case Details

VAERS ID: 544001 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Florida  
Vaccinated:2014-09-09
Onset:2014-09-16
   Days after vaccination:7
Submitted: 2014-09-17
   Days after onset:1
Entered: 2014-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7J77Y / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016186 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H69837 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB430A / 1 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Haematochezia, Intussusception, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (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, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound
CDC Split Type:

Write-up: Patient presented with bloody stools and emesis and had intussusception confirmed on ultrasound


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20141014&IDNUMBER=544001


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