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. |