This is VAERS ID 277783

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID:	277783 (history)
Form:	Version .0
Age:	0.2
Gender:	Male
Location:	Arizona

Vaccinated:	2007-03-08
Onset:	2007-04-24
Days after vaccination:	47
Submitted:	2007-05-02
Days after onset:	8
Entered:	2007-05-02

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B059CA / 0	LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	1272F / 0	RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B08684D / 0	RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1231F / 0	- / PO

Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception, Laparotomy
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=277783