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This is VAERS ID 497444

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

Case Details

VAERS ID: 497444 (history)  
Form: Version 1.0  
Age: 0.19  
Gender: Male  
Location: Michigan  
Vaccinated:2013-06-03
Onset:2013-07-20
   Days after vaccination:47
Submitted: 2013-07-23
   Days after onset:3
Entered: 2013-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B421AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04774 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 1 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Abdominal X-ray, Dehydration, Enema administration, Intussusception, Ultrasound abdomen abnormal, Urine output decreased, Vomiting, X-ray normal
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No allergies, defects, medical conditions.
Allergies:
Diagnostic Lab Data: U/S abdomen --$g positive for intussusception
CDC Split Type:

Write-up: Patient had vomiting for a day with every feed, decreased urine output, severe dehydration. Started on 7/20, for about 10 episodes before - hospitalization. U/S abd - Intussusception. Got enema reduction and f/u x-ray showed no intussusception. He recovered after enema.


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