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This is VAERS ID 315531

Case Details

VAERS ID: 315531 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Foreign  
Vaccinated:2008-05-05
Onset:2008-05-10
   Days after vaccination:5
Submitted: 2008-06-06
   Days after onset:27
Entered: 2008-06-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Ultrasound scan normal
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Barium enema of opaque colon (results: quick filling of all the colic frame, which has a normal magnitude and structure. The valve passes well and 15 cm of terminal ileus. No existence of invagination.) and ultrasound scan (results: no findings) were done on 12-May-2008.
CDC Split Type: ESWYEG01638908

Write-up: Information regarding PREVENAR was received from a healthcare professional via a regulatory authority regarding a 3-month-old male patient who experienced intussusception. The patient received a dose on 05-May-2008. The patient experienced intussusception on 10-May-2008. The patient was hospitalized. On 12-May-2008 the patient was spontaneously recovered. No additional information was available at the time of this report.


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