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This is VAERS ID 476119

(NOTE: This result is from the 8/12/2013 version of the VAERS database)

Case Details

VAERS ID: 476119 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Florida  
Vaccinated:2012-10-01
Onset:2012-10-11
   Days after vaccination:10
Submitted: 2012-12-03
   Days after onset:53
Entered: 2012-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B326CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UH527AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70996 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB287A / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Undescended R testis, NKDA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had intussusception and had surgical repair at Hospital.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130812&IDNUMBER=476119


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