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This is VAERS ID 386671

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 386671 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Washington  
Vaccinated:2010-04-14
Onset:2010-04-28
   Days after vaccination:14
Submitted: 2010-05-04
   Days after onset:6
Entered: 2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3556AA / 3 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E45349 / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1213Y / 3 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Barium enema, Blood test, Intussusception, Ultrasound abdomen, Vomiting, X-ray
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC Split Type:

Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID.


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