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This is VAERS ID 525170

(NOTE: This result is from the 6/14/2014 version of the VAERS database)

Case Details

VAERS ID: 525170 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Arizona  
Vaccinated:2014-02-12
Onset:2014-02-18
   Days after vaccination:6
Submitted: 2014-03-07
   Days after onset:17
Entered: 2014-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7449K / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J010385 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H00137 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB397A / 0 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Intussusception, Ultrasound abdomen, Urinary system X-ray
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: KUB; Abdominal ultrasound; Barium enema
CDC Split Type:

Write-up: Intussusception requiring hospitalization. Intussusception occurred 6 days after rotavirus, DTaP, HepB, IPV, Hib, OMP, PCV13.


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