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This is VAERS ID 406334

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

Case Details

VAERS ID: 406334 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Colorado  
Vaccinated:2010-09-01
Onset:2010-10-23
   Days after vaccination:52
Submitted: 2010-11-01
   Days after onset:9
Entered: 2010-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B205AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH019AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60220 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Barium enema abnormal, Cough, Decreased activity, Dehydration, Diarrhoea, Eye discharge, Gastrointestinal sounds abnormal, Haematochezia, Hypophagia, Intussusception, Irritability, Laparoscopic surgery, Laparotomy, Occult blood positive, Platelet count increased, Pyrexia, Surgery, Urinary system X-ray, Urine output decreased, Viral infection, Vomiting, White blood cell count increased, X-ray abnormal
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had intussusception on 10/23/10 which required surgical reduction.


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