VAERS ID: |
315579 (history) |
Form: |
Version .0 |
Age: |
0.5 |
Gender: |
Male |
Location: |
North Carolina |
Vaccinated: | 2008-05-30 |
Onset: | 2008-06-03 |
Days after vaccination: | 4 |
Submitted: |
2008-06-04 |
Days after onset: | 1 |
Entered: |
2008-06-09 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B142AA / 2 |
RL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF350AA / 2 |
LL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
C65929 / 2 |
LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0211X / 2 |
- / PO |
Administered by: Private Purchased by: Private Symptoms: Appendicectomy,
Intussusception,
Laparoscopy SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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, 1 days
Extended hospital stay? Yes
Previous Vaccinations: Other Medications: TYLENOL Current Illness: hematochezia Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery. |