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This is VAERS ID 337061

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

VAERS ID: 337061 (history)  
Form: Version .0  
Age: 0.4  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2008-12-10
Onset:2009-01-08
   Days after vaccination:29
Submitted: 2009-01-12
   Days after onset:4
Entered: 2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal distension, Abdominal pain, Constipation, Crying, Enema administration, Hypophagia, Intussusception, Lethargy, Metabolic function test normal, Occult blood negative, Ultrasound abdomen abnormal, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC Split Type:

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


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