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This is VAERS ID 382920

Case Details

VAERS ID: 382920 (history)  
Form: Version 1.0  
Age: 0.24  
Sex: Female  
Location: Michigan  
Vaccinated:2010-03-11
Onset:2010-03-14
   Days after vaccination:3
Submitted: 2010-03-18
   Days after onset:3
Entered: 2010-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3429AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB735AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Double intussusceptum.


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