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This is VAERS ID 502837

Case Details

VAERS ID: 502837 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Female  
Location: Maine  
Vaccinated:2013-09-05
Onset:2013-09-11
   Days after vaccination:6
Submitted: 2013-09-17
   Days after onset:6
Entered: 2013-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4452AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. H017304 / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH807AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1281 / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G43220 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Enema administration, Intussusception
SMQs:, Gastrointestinal obstruction (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema reduced
CDC Split Type:

Write-up: Intussusception 5 days after ROTARIX.


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