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This is VAERS ID 515482

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

Case Details

VAERS ID: 515482 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Male  
Location: Nevada  
Vaccinated:2013-11-21
Onset:2013-11-26
   Days after vaccination:5
Submitted: 2013-12-03
   Days after onset:7
Entered: 2013-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57035 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS AHDB397A / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Colectomy, Intussusception
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
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: Patient taken to OR -$g hemicolectomy
CDC Split Type:

Write-up: 11/26/2013 Severe Other. Pt went to ER with Dx: Intussusception.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=515482


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