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This is VAERS ID 486747

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 486747 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Male  
Location: New York  
Vaccinated:2013-02-05
Onset:2013-03-07
   Days after vaccination:30
Submitted: 2013-03-12
   Days after onset:4
Entered: 2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intestinal operation, Intussusception, Ultrasound scan normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=486747


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