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This is VAERS ID 450583

(NOTE: This result is from the 4/11/2012 version of the VAERS database)

Case Details

VAERS ID: 450583 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Illinois  
Vaccinated:2011-12-30
Onset:2012-01-23
   Days after vaccination:24
Submitted: 2012-02-27
   Days after onset:35
Entered: 2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3979AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91621 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB206A / 1 - / PO

Administered by: Unknown       Purchased by: Public
Symptoms: Abdominal pain, Intussusception, Ultrasound abdomen, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC Split Type:

Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20120411&IDNUMBER=450583


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