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This is VAERS ID 539638

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

Case Details

VAERS ID: 539638 (history)  
Form: Version .0  
Age: 0.35  
Gender: Male  
Location: Louisiana  
Vaccinated:2014-07-24
Onset:2014-07-26
   Days after vaccination:2
Submitted: 2014-08-12
   Days after onset:17
Entered: 2014-08-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 9EA47 / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K001124 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H45100 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB418A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema, Computerised tomogram abdomen abnormal, Crying, Enema administration, Intussusception, Irritability, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CT scan - abd.
CDC Split Type:

Write-up: Presented to E.R. on 7/26 evening with hx of crying, irritability and bilious vomiting 15 x''s approx. 10-12 hrs. Workup/CT abd revealed intussusception 5-6cm. A.M. of 7/27 pt. was transferred to hosp. via ambulance. Barium enema performed and intussusception resolved without surgery. D/c''d home on 7/28/14.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=539638


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