| VAERS ID: |
285725 (history) |
| Form: |
Version .0 |
| Age: |
0.5 |
| Gender: |
Male |
| Location: |
Missouri |
| Vaccinated: | 2007-07-03 |
| Onset: | 2007-07-05 |
| Days after vaccination: | 2 |
| Submitted: |
2007-07-24 |
| Days after onset: | 19 |
| Entered: |
2007-07-24 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B132BA / 2 |
LL / IM |
| PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
B58845H / 2 |
RL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0503U / 0 |
- / PO |
Administered by: Private Purchased by: Private
Symptoms: Blood glucose,
Inappropriate schedule of drug administration,
Intussusception,
Lethargy,
Pallor,
Ultrasound abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (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? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC Split Type:
Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema. |
