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 |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21BC03AA / 1 |
RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1159R / 1 |
LL / IM |
PNC: PNEUMO (PREVNAR7) / LEDERLE LABORATORIES |
B08657F / 1 |
LL / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0695F / 1 |
- / PO |
Administered by: Private Purchased by: Public Symptoms: Abdominal pain,
Appendicectomy,
Barium enema,
Haematochezia,
Intussusception,
Laparotomy,
Surgery,
Vomiting 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 records received 4/24/07-Gastrografin enema water soluble attempt unsuccessful. 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 that04/24/07-records received from facility for DOS 03/14-03/15/07. DC DX: Intussusception Ileocolic. HX of emesis and bloody stools. Gastrografin enema water soluble attempt unsuccessful. Exploratory laparotomy with manual reduction of intussusception. Incidental appendectomy. problem. |