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This is VAERS ID 380464

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 380464 (history)  
Form: Version .0  
Age: 0.3  
Sex: Male  
Location: California  
Vaccinated:2010-01-18
Onset:2010-01-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2010-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3564AA / 1 UN / IM
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D67170 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomited twice day prior and once this morning
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: abd u/s positive with intussusception
CDC Split Type:

Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100302&IDNUMBER=380464


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