| 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. |
