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This is VAERS ID 380464

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 380464 (history)  
Form: Version 1.0  
Age: 0.34  
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 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D67170 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0574Y / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Barium enema, Intussusception, Ultrasound abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), 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, 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=20180814&IDNUMBER=380464


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