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This is VAERS ID 418360

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

Case Details

VAERS ID: 418360 (history)  
Form: Version .0  
Age: 0.4  
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 / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH093AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E63007 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB058A / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal pain, Blood calcium increased, Blood sodium decreased, Constipation, Crying, Gastrointestinal tube insertion, Haematochezia, Laboratory test, Leukocytosis, Mucous stools, Occult blood positive, Platelet count increased, Screaming, Ultrasound abdomen normal, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Depression (excl suicide and self injury) (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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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110413&IDNUMBER=418360


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