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This is VAERS ID 542759

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

Case Details

VAERS ID: 542759 (history)  
Form: Version 1.0  
Age: 0.21  
Gender: Male  
Location: Minnesota  
Vaccinated:2014-08-22
Onset:2014-08-27
   Days after vaccination:5
Submitted: 2014-08-27
   Days after onset:0
Entered: 2014-09-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B23P9 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J016187 / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H33597 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB416A / 1 MO / PO

Administered by: Public       Purchased by: Private
Symptoms: Abdominal X-ray, Intussusception, Ultrasound abdomen, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal ultrasound/Xray
CDC Split Type:

Write-up: Intussusception - fluoroscopically reduced. Presented with vomiting.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=542759


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