National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 281104

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 281104 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Arizona  
Vaccinated:2007-05-02
Onset:2007-06-03
   Days after vaccination:32
Submitted: 2007-06-07
   Days after onset:4
Entered: 2007-06-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UE924AA / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0018 / 1 UN / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442A / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Cardiac murmur, Colectomy, Colostomy, Culture negative, Echocardiogram abnormal
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Cardiomyopathy (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Intussusception
CDC Split Type:

Write-up: Intussusception


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=281104


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166