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This is VAERS ID 405245

(NOTE: This result is from the 5/13/2011 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: Intussusception, Large intestinal obstruction reduction, Small intestinal intussusception reduction, Ultrasound abdomen
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow)

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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