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This is VAERS ID 384610

(NOTE: This result is from the 5/13/2013 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) / PFIZER/WYETH D90887 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0321Y / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal distension, Colectomy, Condition aggravated, Culture stool negative, Diarrhoea, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intestinal resection, Intussusception, Lethargy, Occult blood positive, Stool analysis abnormal, Surgery, Vomiting, White blood cell count increased, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

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=20130513&IDNUMBER=384610


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