VAERS ID: |
277783 (history) |
Form: |
Version .0 |
Age: |
0.2 |
Gender: |
Male |
Location: |
Arizona |
Vaccinated: | 2007-03-08 |
Onset: | 2007-04-24 |
Days after vaccination: | 47 |
Submitted: |
2007-05-02 |
Days after onset: | 8 |
Entered: |
2007-05-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B059CA / 0 |
LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1272F / 0 |
RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
B08684D / 0 |
RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1231F / 0 |
- / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Intussusception,
Laparotomy SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy. |