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This is VAERS ID 452398

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 452398 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Maryland  
Vaccinated:2012-03-12
Onset:2012-03-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH317AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916599 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB207A / 0 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Intestinal anastomosis, Intussusception, Septic shock, Small intestinal resection
SMQs:, Agranulocytosis (broad), Toxic-septic shock conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Terminal ileum & cecum resection with end to end anastomosis
CDC Split Type:

Write-up: Child presented with intussusception & septic shock on 3/19/12.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=452398


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