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This is VAERS ID 337061

(NOTE: This result is from the 10/14/2018 version of the VAERS database)

Case Details

VAERS ID: 337061 (history)  
Form: Version 1.0  
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 / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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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