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This is VAERS ID 337851

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 337851 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Maine  
Vaccinated:2008-12-30
Onset:2009-01-11
   Days after vaccination:12
Submitted: 2009-01-15
   Days after onset:4
Entered: 2009-01-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Blood count, Blood culture, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC Split Type: ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180214&IDNUMBER=337851


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