| 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 |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B079BA / 2 |
- / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF011AA / 2 |
- / IM |
| PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC |
B08670E / 2 |
- / IM |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1082F / 2 |
- / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium double contrast,
Decreased appetite,
Dehydration,
Intussusception,
Somnolence,
Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
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 records received 6/20/07-air enema reduction
CDC Split Type:
Write-up: Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level. |
