| VAERS ID: |
278583 (history) |
| Form: |
Version .0 |
| Age: |
0.8 |
| Gender: |
Male |
| Location: |
Colorado |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
2007-05-07 |
| Entered: |
2007-05-15 |
| Days after submission: | 8 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B079BA / 2 |
- / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF011AA / 2 |
- / IM |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
B08670E / 2 |
- / IM |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1082F / 2 |
- / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Barium double contrast,
Decreased appetite,
Dehydration,
Intussusception
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), 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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Air enema diagnosed and reduced obstruction
CDC Split Type:
Write-up: Vomiting, dehydration, had intussusception reduced with air enema. |
