VAERS ID: |
278694 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Gender: |
Female |
Location: |
Michigan |
Vaccinated: | 2007-03-22 |
Onset: | 2007-05-06 |
Days after vaccination: | 45 |
Submitted: |
2007-05-08 |
Days after onset: | 2 |
Entered: |
2007-05-16 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B084CA / 2 |
RL / - |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0062U / 2 |
LL / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08646C / 2 |
LL / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1235F / 3 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Barium enema,
Haematochezia,
Intussusception,
Pain SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Tobrex eye drops 11/15 Current Illness: Only dacryostenosis Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia Allergies:
Diagnostic Lab Data: Barium enema CDC Split Type:
Write-up: Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools |