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This is VAERS ID 315579

Case Details

VAERS ID: 315579 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: North Carolina  
Vaccinated:2008-05-30
Onset:2008-06-03
   Days after vaccination:4
Submitted: 2008-06-04
   Days after onset:1
Entered: 2008-06-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception
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, 1 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


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