This is VAERS ID 435399

(NOTE: This result is from the 10/11/2011 version of the VAERS database)

Case Details

VAERS ID:	435399 (history)
Form:	Version .0
Age:	0.3
Gender:	Male
Location:	Rhode Island

Vaccinated:	2011-09-16
Onset:	0000-00-00
Submitted:	2011-09-22
Entered:	2011-09-22

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B277AB / 0	UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0254DA / 0	UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH	916007 / 0	UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	A41FB159A / 0	- / PO

Administered by: Private Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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: 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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20111011&IDNUMBER=435399