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This is VAERS ID 432805

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 432805 (history)  
Form: Version 1.0  
Age: 0.37  
Gender: Male  
Location: California  
Vaccinated:2011-07-12
Onset:2011-07-19
   Days after vaccination:7
Submitted: 2011-08-30
   Days after onset:42
Entered: 2011-09-01
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916007 / 2 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB155A / 2 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? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ROTATEQ was administered on 7/12/11. Pt. went to ER on 7/19/11 with bilious emesis - had surgery for suspicion per mother and had ileocolic intussusception.


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