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This is VAERS ID 437718

(NOTE: This result is from the 4/14/2017 version of the VAERS database)

Case Details

VAERS ID: 437718 (history)  
Form: Version .0  
Age: 0.18  
Gender: Male  
Location: New York  
Vaccinated:2011-09-29
Onset:2011-10-09
   Days after vaccination:10
Submitted: 2011-10-11
   Days after onset:2
Entered: 2011-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39138A / 0 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. AHBVC032AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915383 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB159A / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Intussusception w/ surgical correction.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170414&IDNUMBER=437718


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