VAERS ID: |
274817 (history) |
Form: |
Version .0 |
Age: |
0.3 |
Gender: |
Male |
Location: |
Missouri |
Vaccinated: | 2007-02-05 |
Onset: | 2007-03-18 |
Days after vaccination: | 41 |
Submitted: |
2007-03-26 |
Days after onset: | 8 |
Entered: |
2007-03-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B074AA / 1 |
LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0407F / 1 |
RL / IM |
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES |
B086840 / 1 |
RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1114F / 1 |
- / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Abdominal pain,
Barium double contrast,
Diarrhoea haemorrhagic,
Enema administration,
Haematochezia SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: air contrast enema, abd ultrasound CDC Split Type:
Write-up: 3/18/07 went to Hospital ER for vomiting and bloody diarrhea. Diagnosed with intussusception. Treated with reduction twice. Hospitalized 3/18-3/20/07. |