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This is VAERS ID 524481

(NOTE: This result is from the 3/14/2015 version of the VAERS database)

Case Details

VAERS ID: 524481 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: Missouri  
Vaccinated:2013-07-11
Onset:2013-10-09
   Days after vaccination:90
Submitted: 2014-03-04
   Days after onset:146
Entered: 2014-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 5GS71 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J000360 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G31938 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB292A / 2 - / PO

Administered by: Unknown       Purchased by: Other
Symptoms: Enema administration, Intussusception, Ultrasound abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: Sickle cell trait, umbilical hernia, feeding problems in the newborn
Allergies:
Diagnostic Lab Data: Ultrasound for diagnosis and air enema for reduction.
CDC Split Type:

Write-up: Intussusception diagnosed by ultrasound reduced by air enema October 9th, 2013. Observed overnight, discharged home in good condition October 10th, 2013.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20150314&IDNUMBER=524481


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