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This is VAERS ID 418360

Case Details

VAERS ID: 418360 (history)  
Form: Version 1.0  
Age: 0.36  
Gender: Male  
Location: Mississippi  
Vaccinated:2010-07-21
Onset:2010-07-21
   Days after vaccination:0
Submitted: 2011-03-10
   Days after onset:232
Entered: 2011-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B188AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception, Laboratory test, Screaming
SMQs:, Gastrointestinal obstruction (narrow), Hostility/aggression (broad)

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

Write-up: Constant screaming...Took to ER. Has intussusception. Given morphine and flown by air to another facility. Self-corrected.


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