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This is VAERS ID 494301

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

Case Details

VAERS ID: 494301 (history)  
Form: Version .0  
Age: 0.31  
Gender: Male  
Location: Alabama  
Vaccinated:2013-03-26
Onset:2013-04-13
   Days after vaccination:18
Submitted: 2013-06-14
   Days after onset:62
Entered: 2013-06-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4363AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH771AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1058 / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB315A / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception, Large intestine perforation, Surgery
SMQs:, Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow), Ischaemic colitis (narrow)

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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4/13/13 surgery for colonic perforation after intussusception.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=494301


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