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This is VAERS ID 495671

Case Details

VAERS ID: 495671 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Male  
Location: Michigan  
Vaccinated:2013-05-13
Onset:2013-06-27
   Days after vaccination:45
Submitted: 2013-07-02
   Days after onset:5
Entered: 2013-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4359AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G75071 / 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB346A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Barium enema, Condition aggravated, Dehydration, Intussusception, Irritability, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypoglycaemia (broad), Dehydration (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:
Current Illness: Mild URI; Mild ROM; Vomiting day before
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; Barium enema
CDC Split Type:

Write-up: 6.27.13 started with vomiting; 6.28.13 vomiting and very fussy, dehydrated. Sent to hospital for evaluation and IV rehydration. Intussusception diagnosed and treated by barium enema.


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