| VAERS ID: |
267943 (history) |
| Form: |
Version .0 |
| Age: |
0.3 |
| Gender: |
Female |
| Location: |
New York |
| Vaccinated: | 2006-09-18 |
| Onset: | 2006-11-05 |
| Days after vaccination: | 48 |
| Submitted: |
2006-11-29 |
| Days after onset: | 24 |
| Entered: |
2006-11-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B059DA / 1 |
UN / IM |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0085 / 1 |
UN / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08657K / 1 |
UN / IM |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0146F / 1 |
- / PO |
Administered by: Public Purchased by: Public
Symptoms: Abdominal X-ray,
Enema administration,
Intussusception,
Lethargy,
Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zantac
Current Illness:
Preexisting Conditions: GERD; SC trait: SGA Birth HX: full term, normal vag delivery, no complications. PMH: GERD, small for gestational age.
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed IS.
CDC Split Type:
Write-up: Intussusception 11/5/06 - 11/09/06 reduced with Ba enema. 12/8/06 Received medical records from hospital which reveal patient experienced a week of vomiting prior to admit. No fever & no sick contacts. Lethargic on admission 11/3/06 & anterior fontanelle was depressed & mucous membranes dry. Abdomen was soft with no masses or distention. Surgical consult done. Air enema relieved the IS. No further vomiting & patient d/c to home on 11/8/06. |
