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This is VAERS ID 380180

(NOTE: This result is from the 6/14/2014 version of the VAERS database)

Case Details

VAERS ID: 380180 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Arkansas  
Vaccinated:2009-08-19
Onset:2009-09-18
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2010-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF596AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA859 / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal pain, Appendicectomy, Barium enema, Dehydration, Enema administration, Explorative laparotomy, Intussusception, Lethargy, Ultrasound abdomen abnormal, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Flat plate Abd; Barium enema ultrasound, had exploratory surgery for intussusception 09/19/09
CDC Split Type:

Write-up: Vomiting-$gdehydration-$gintussusception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20140614&IDNUMBER=380180


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