National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 368114

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 368114 (history)  
Form: Version .0  
Age: 0.6  
Gender: Male  
Location: Iowa  
Vaccinated:2009-10-26
Onset:2009-10-31
   Days after vaccination:5
Submitted: 2009-11-09
   Days after onset:9
Entered: 2009-11-17
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Metabolic function test, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC Split Type:

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=368114


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