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This is VAERS ID 341569

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

Case Details

VAERS ID: 341569 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Alaska  
Vaccinated:2008-10-20
Onset:2009-03-08
   Days after vaccination:139
Submitted: 2009-03-11
   Days after onset:2
Entered: 2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (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: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen could represent changes of intussuception.
CDC Split Type:

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20181014&IDNUMBER=341569


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