| VAERS ID: |
273125 (history) |
| Form: |
Version .0 |
| Age: |
0.2 |
| Gender: |
Male |
| Location: |
New York |
| Vaccinated: | 2007-01-17 |
| Onset: | 2007-02-20 |
| Days after vaccination: | 34 |
| Submitted: |
2007-02-27 |
| Days after onset: | 7 |
| Entered: |
2007-02-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B069AA / 0 |
RL / IM |
| HIBV: HIB (ACTHIB) / AVENTIS PASTEUR |
UE915AA / 0 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES |
B08672F / 0 |
RL / IM |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0847F / 0 |
- / PO |
Administered by: Private Purchased by: Public
Symptoms: Crying,
Feeding disorder of infancy or early childhood,
Insomnia,
Intussusception,
Pyrexia,
Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Neonatal disorders (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:
Preexisting Conditions: no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: As per the clinic that Patient mom took patient she went to clinic at 2pm complaining that the child would not sleep crying since 3:30am would not eat anything vomiting 4 times at home and once in the clinic pt had fever was sent to lincoln hospital and diagnosed with intussusception of the intestines |
