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This is VAERS ID 509638

(NOTE: This result is from the 3/14/2014 version of the VAERS database)

Case Details

VAERS ID: 509638 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: California  
Vaccinated:2013-10-18
Onset:2013-10-24
   Days after vaccination:6
Submitted: 2013-10-25
   Days after onset:1
Entered: 2013-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS XL99H / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH857AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73023 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB380A / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Intussusception, Surgery, Urinary system X-ray, X-ray with contrast upper gastrointestinal tract
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Upper GI
CDC Split Type:

Write-up: Intussusception presented 6 days after vaccines administered. Surgical treatment was required.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20140314&IDNUMBER=509638


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