VAERS ID: |
303591 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Gender: |
Female |
Location: |
Iowa |
Vaccinated: | 2007-10-24 |
Onset: | 2008-01-13 |
Days after vaccination: | 81 |
Submitted: |
2008-01-25 |
Days after onset: | 12 |
Entered: |
2008-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B124CA / 3 |
LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0676U / 3 |
RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08700K / 3 |
RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1391U / 3 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Intussusception,
Ultrasound scan SMQs:, Gastrointestinal obstruction (narrow)
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, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt. CDC Split Type:
Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp. |