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This is VAERS ID 383724

Case Details

VAERS ID: 383724 (history)  
Form: Version 1.0  
Age: 0.52  
Sex: Male  
Location: Maryland  
Vaccinated:2009-09-01
Onset:2009-12-09
   Days after vaccination:99
Submitted: 2010-03-24
   Days after onset:104
Entered: 2010-03-29
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3143AA, C3397A / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1487X / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Lethargy, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intussusception - open reduction on 12-22-09. Sx''s assoc. were: V (bileous)/lethargy.


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