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This is VAERS ID 425901

Case Details

VAERS ID: 425901 (history)  
Form: Version 1.0  
Age: 0.19  
Gender: Male  
Location: Michigan  
Vaccinated:2011-06-01
Onset:2011-06-05
   Days after vaccination:4
Submitted: 2011-06-10
   Days after onset:5
Entered: 2011-06-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3807AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB807DA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 915703 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB158A / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Transferred after birth to larger hosp. for r/o sepsis and breathing difficulty.
Allergies:
Diagnostic Lab Data: Had surgery for intussusception. In hospital for 10 days.
CDC Split Type:

Write-up: 6/6/11 acute vomiting.


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