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This is VAERS ID 375896

Case Details

VAERS ID: 375896 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Unknown  
Vaccinated:2009-10-27
Onset:2009-12-16
   Days after vaccination:50
Submitted: 2009-12-28
   Days after onset:12
Entered: 2010-01-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3482AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0433Y / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intestinal resection, Intussusception
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow)

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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intussusception - Surgical reduction/resection of small piece of intestine.


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