| VAERS ID: |
261949 (history) |
| Form: |
Version 1.0 |
| Age: |
0.35 |
| Gender: |
Unknown |
| Location: |
Texas |
| Vaccinated: | 2006-07-18 |
| Onset: | 2006-08-10 |
| Days after vaccination: | 23 |
| Submitted: |
0000-00-00 |
| Entered: |
2006-08-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B056AA / 2 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B086560 / UNK |
RL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0139F / 1 |
MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Apnoea,
Intussusception,
Pyrexia,
Urinary tract infection,
Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Received rotavirus shot 7/18/06. Diagnosed with Intussusception 8/10/06. Medical record states apnea, urinary tract infection, vomiting, fever. msv |
