| VAERS ID: |
360569 (history) |
| Form: |
Version .0 |
| Age: |
0.2 |
| Gender: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2009-09-28 |
| Onset: | 2009-10-06 |
| Days after vaccination: | 8 |
| Submitted: |
2009-10-17 |
| Days after onset: | 11 |
| Entered: |
2009-10-13 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3427AA / 0 |
UN / IM |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBVB708A / 0 |
UN / IM |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
D57302 / 0 |
UN / IM |
| ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FA860A / 0 |
- / PO |
Administered by: Private Purchased by: Public
Symptoms: Abdominal X-ray,
Abdominal pain,
Blood potassium decreased,
Decreased activity,
Dysuria,
Faeces discoloured,
Gastrointestinal tube insertion,
Haemoglobin decreased,
Hypophagia,
Hypotonia,
Intestinal obstruction,
Intussusception,
Lethargy,
Lymphocyte percentage decreased,
Malaise,
Mean cell haemoglobin decreased,
Mean cell volume decreased,
Monocyte count increased,
Neutrophil percentage increased,
Platelet count increased,
Rhinorrhoea,
Somnolence,
Urine abnormality,
Vomiting,
X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service d
CDC Split Type:
Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility. |
