VAERS ID: |
351299 (history) |
Form: |
Version .0 |
Age: |
0.58 |
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) / PFIZER/WYETH |
D34438 / 2 |
LL / IM |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41DA734A / 2 |
- / PO |
Administered by: Private Purchased by: Public Symptoms: Intussusception,
Surgery SMQs:, Gastrointestinal obstruction (narrow)
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. |