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This is VAERS ID 405245

(NOTE: This result is from the 4/13/2011 version of the VAERS database)

Case Details

VAERS ID: 405245 (history)  
Form: Version .0  
Age: 0.6  
Gender: Male  
Location: California  
Vaccinated:2010-07-12
Onset:2010-10-03
   Days after vaccination:83
Submitted: 2010-10-25
   Days after onset:22
Entered: 2010-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3622AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB789AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49136 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB056A / 2 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal X-ray, Asthenia, Blood culture negative, Constipation, Enema administration, Intussusception, Irritability, Ultrasound abdomen abnormal, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC Split Type:

Write-up: RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL


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