| VAERS ID: |
284028 (history) |
| Form: |
Version .0 |
| Age: |
0.5 |
| Gender: |
Female |
| Location: |
Georgia |
| Vaccinated: | 2007-04-13 |
| Onset: | 2007-06-23 |
| Days after vaccination: | 71 |
| Submitted: |
2007-07-06 |
| Days after onset: | 13 |
| Entered: |
2007-07-06 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C2570BA / 2 |
RL / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF093AA / 2 |
LL / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
Z0548 / 2 |
RL / IM |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
B08670B / 2 |
LL / IM |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0024U / 2 |
- / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal X-ray,
Bowel sounds abnormal,
Diarrhoea,
Enema administration,
Intussusception,
Pallor,
Ultrasound abdomen abnormal,
Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t
CDC Split Type:
Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception. |
