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This is VAERS ID 455056

Case Details

VAERS ID: 455056 (history)  
Form: Version 1.0  
Age: 0.44  
Gender: Male  
Location: Georgia  
Vaccinated:2012-04-27
Onset:2012-04-29
   Days after vaccination:2
Submitted: 2012-05-04
   Days after onset:5
Entered: 2012-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4082AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F27290 / 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB215A / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI/Cough
Preexisting Conditions: Bronchiolitis/wheezing (3/18/12)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 4/29/12 pt was diagnosed with intussusception requiring surgery. Had rotavirus vaccine on 4/27/12.


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