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This is VAERS ID 331812

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 331812 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Tennessee  
Vaccinated:2008-10-21
Onset:2008-10-29
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2008-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192DA / 3 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF401AB / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C80901 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0642X / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema 12/15/08-Diagnostic reports received for DOS 11/2/08-Air contrast enema attempted to reduce intussusception unsuccessful. Partial reduction of ileal ileal intussusception. Surgery with incidental appendectomy.
CDC Split Type:

Write-up: Intussusception diagnosed on 11/2/08 around 4-5 p.m. Symptoms of emesis, colicky ab pain began 10/29/08 in the afternoon. 12/24/08-records received for DOS 11/2-11/3/08-DC DX: Intussusception of small bowel into the cecum. History of crampy abdominal pain for several days intermittent with some blood tinged stools. Reduction of small bowel intussusception with air contrast enema and exploratory laparotomy open appendectomy. In operating room it was found that the intussusception was completely reduced.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180914&IDNUMBER=331812


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