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This is VAERS ID 463115

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

Case Details

VAERS ID: 463115 (history)  
Form: Version .0  
Age: 0.5  
Gender: Female  
Location: Hawaii  
Vaccinated:2012-08-14
Onset:2012-08-21
   Days after vaccination:7
Submitted: 2012-08-24
   Days after onset:3
Entered: 2012-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4184AB / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC103AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB270A / 1 - / PO

Administered by: Unknown       Purchased by: Public
Symptoms: Barium double contrast, Enema administration, Intussusception, Ultrasound scan, X-ray
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? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Plain films, ultrasound, barium/air enema
CDC Split Type:

Write-up: Intussusception.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=463115


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