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This is VAERS ID 384610

(NOTE: This result is from the 5/11/2010 version of the VAERS database)

Case Details

VAERS ID: 384610 (history)  
Form: Version .0  
Age: 0.2  
Sex: Female  
Location: Oklahoma  
Vaccinated:2010-03-29
Onset:2010-04-03
   Days after vaccination:5
Submitted: 2010-04-08
   Days after onset:5
Entered: 2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB769AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D90887 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Diarrhoea, Intestinal resection, Intussusception, Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: URI 3/24/10 - Resolved at visit; Eczema
Allergies:
Diagnostic Lab Data: Done at outside facility - no access to records
CDC Split Type:

Write-up: Pt developed vomiting and diarrhea and lethargy. Dx of intussusception. Tx bowel resection.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100511&IDNUMBER=384610


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