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This is VAERS ID 522387

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 522387 (history)  
Form: Version .0  
Age: 0.19  
Gender: Male  
Location: Alabama  
Vaccinated:2013-12-06
Onset:2013-12-12
   Days after vaccination:6
Submitted: 2014-02-05
   Days after onset:55
Entered: 2014-02-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5A5T5 / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH854AB / 0 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G66539 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB355A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Colectomy, Enema administration, Haematochezia, Intussusception, Lethargy, Surgery, Ultrasound abdomen, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypoglycaemia (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Impetigo
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abd. Ultrasound/Barium enema
CDC Split Type:

Write-up: Went to ER due to vomiting and bloody stools, also lethargic on 12-12-13 was admitted. Abd. ultrasound and barium enema was done. Was diagnosed with intussusception. Was taken to surgery where he had 2 inches of colon removed.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=522387


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