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This is VAERS ID 435399

Case Details

VAERS ID: 435399 (history)  
Form: Version 1.0  
Age: 0.31  
Gender: Male  
Location: Rhode Island  
Vaccinated:2011-09-16
Onset:2011-09-20
   Days after vaccination:4
Submitted: 2011-09-22
   Days after onset:2
Entered: 2011-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B277AB / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB159A / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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: None
Current Illness: Stuffy nose; Cough
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ? was in ER
CDC Split Type:

Write-up: Intussusception on (9/20/2011).


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