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This is VAERS ID 261949

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

VAERS ID: 261949 (history)  
Form: Version .0  
Age: 0.4  
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
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B056AA / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B086560 / - RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / 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 perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (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? 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.


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