| VAERS ID: |
351299 (history) |
| Form: |
Version .0 |
| Age: |
0.6 |
| Gender: |
Female |
| Location: |
South Carolina |
| Vaccinated: | 2009-05-28 |
| Onset: | 2009-06-15 |
| Days after vaccination: | 18 |
| Submitted: |
2009-07-07 |
| Days after onset: | 22 |
| Entered: |
2009-07-14 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3224AA / 2 |
LL / IM |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBVB736AA / 2 |
RL / IM |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
034438 / 2 |
LL / IM |
| ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41DA734A / 2 |
- / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium double contrast,
Blood amylase,
Blood culture,
Chest X-ray,
Full blood count,
Intussusception,
Lethargy,
Metabolic function test,
Nausea,
Occult blood positive,
Pyrexia,
Rectal haemorrhage,
Surgery,
Urine analysis,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC Split Type:
Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done. |
