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This is VAERS ID 406334

(NOTE: This result is from the 5/13/2013 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
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB056A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=406334


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