| VAERS ID: |
268134 (history) |
| Form: |
Version .0 |
| Age: |
0.2 |
| Gender: |
Female |
| Location: |
California |
| Vaccinated: | 2006-11-14 |
| Onset: | 2006-11-29 |
| Days after vaccination: | 15 |
| Submitted: |
2006-12-01 |
| Days after onset: | 2 |
| Entered: |
2006-12-01 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR |
C2650AA / 0 |
LL / IM |
| HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. |
0679F / 0 |
RL / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR |
41031 / 0 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES |
B08689D / 0 |
RL / IM |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0848F / 0 |
- / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Anaemia,
Haematochezia,
Intussusception,
Listless,
Oral intake reduced,
Pallor
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
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, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC Split Type:
Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in hospital and is doing well. |
