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This is VAERS ID 478201

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 478201 (history)  
Form: Version .0  
Age: 0.18  
Gender: Male  
Location: California  
Vaccinated:2012-11-30
Onset:2012-12-06
   Days after vaccination:6
Submitted: 2012-12-15
   Days after onset:9
Entered: 2012-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B344DA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH681AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB304A / 0 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Barium enema normal, Intussusception, Ultrasound scan abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound positive at Medical Center, Barium Enema at Med Ctr negative
CDC Split Type:

Write-up: Vomiting, later presented to outside facility, ultrasound showed intussusception. Transferred to Med Ctr, barium enema done and negative, assumed intussusception self-resolved.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=478201


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