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This is VAERS ID 380355

Case Details

VAERS ID: 380355 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Female  
Location: California  
Vaccinated:2010-01-19
Onset:2010-01-24
   Days after vaccination:5
Submitted: 2010-02-04
   Days after onset:11
Entered: 2010-02-15
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3385AA / UNK UN / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 12504 / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D78697 / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1182Y / UNK MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Intussusception, Ultrasound abdomen
SMQs:, 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: None
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: US to x-ray Exams ABD
CDC Split Type:

Write-up: ileocolic intussusception - reduced 1/24/2010


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