| VAERS ID: |
274772 (history) |
| Form: |
Version .0 |
| Age: |
0.4 |
| Gender: |
Male |
| Location: |
Louisiana |
| Vaccinated: | 2007-01-09 |
| Onset: | 2007-03-12 |
| Days after vaccination: | 62 |
| Submitted: |
2007-03-26 |
| Days after onset: | 14 |
| Entered: |
2007-03-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21BC03AA / 1 |
RL / IM |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1159R / 1 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES |
B08657F / 1 |
LL / - |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0695F / 1 |
- / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal pain,
Appendicectomy,
Barium enema,
Haematochezia,
Intussusception
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:
Write-up: Unsure - dad reported patient brought to ER for abdominal pain and was diagnosed with intussusception and had it surgically repaired at facility reported. Patient never seen here for that problem. |
