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This is VAERS ID 379548

Case Details

VAERS ID: 379548 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: Arizona  
Vaccinated:2010-01-21
Onset:2010-01-27
   Days after vaccination:6
Submitted: 2010-01-30
   Days after onset:3
Entered: 2010-02-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74804 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Intussusception, Surgery, Ultrasound abdomen abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: none
Preexisting Conditions: gastroesophogeal reflux
Allergies:
Diagnostic Lab Data: ultrasound + for intussusception - surgery
CDC Split Type:

Write-up: Intussusception-surgery, hospitalization 6 days after vaccines patient with abd pain, emesis.


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