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This is VAERS ID 352902

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

Case Details

VAERS ID: 352902 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: New York  
Vaccinated:2009-07-24
Onset:2009-07-30
   Days after vaccination:6
Submitted: 2009-07-31
   Days after onset:1
Entered: 2009-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3242AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D48927 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Enema administration, Intussusception, Urinary system X-ray
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: None Allergies: NKDA
Allergies:
Diagnostic Lab Data: KUB: findings which suggest an intussusception with the leading edge in the left transverse colon. The air in the right and transverse colon appears to have been displaced and there is what appears to be dilated small bowel in the right upp
CDC Split Type:

Write-up: intussusception 11/18/2009 ED record for 7/30-7/31/2009. Patient with c/o''s irritability, vomiting. Xrays + for intussusception which was reduced per air enema. F/up xrays noted resolution. DC DX Intussusception. ICD-9 code 560.0


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=352902


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