| VAERS ID: |
352902 (history) |
| Form: |
Version .0 |
| Age: |
0.4 |
| Gender: |
Male |
| Location: |
New York |
| Vaccinated: | 2009-07-24 |
| Onset: | 2009-07-30 |
| Days after vaccination: | 6 |
| Submitted: |
2009-07-31 |
| Days after onset: | 1 |
| Entered: |
2009-07-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3242AA / 0 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D48927 / 1 |
RL / IM |
| ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FA802A / 0 |
- / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Enema administration,
Intussusception,
Urinary system X-ray
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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: None Allergies: NKDA
Allergies:
Diagnostic Lab Data: KUB: findings which suggest an intussusception with the leading edge in the left transverse colon. The air in the right and transverse colon appears to have been displaced and there is what appears to be dilated small bowel in the right upper right quadrant of the abdomen. Air enema: ileo-colo-colic intussusception with satisfactory reduction. Labs none noted Dx studies: Xrays of abdomen + for intussusception, barium enem
CDC Split Type:
Write-up: intussusception 11/18/2009 ED record for 7/30-7/31/2009. DC DX Intussusception Patient with c/o''s irritability, vomiting. Xrays + for intussusception which was reduced per air enema. F/up xrays noted resolution. . ICD-9 code 560.0 | 