| VAERS ID: |
378219 (history) |
| Form: |
Version .0 |
| Age: |
0.3 |
| Gender: |
Female |
| Location: |
Alabama |
| Vaccinated: | 2009-10-15 |
| Onset: | 2010-01-01 |
| Days after vaccination: | 78 |
| Submitted: |
2010-01-19 |
| Days after onset: | 18 |
| Entered: |
2010-01-26 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C3157AA / 1 |
RL / UN |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF727AA / 1 |
RL / UN |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
D0041 / 1 |
LL / UN |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D87185 / 1 |
LL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FA895A / 1 |
- / PO |
Administered by: Private Purchased by: Private
Symptoms: Computerised tomogram abnormal,
Enema administration,
Intestinal resection,
Intussusception,
Laparoscopic surgery,
Lethargy,
Vomiting,
White blood cell count increased,
X-ray
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 10 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC Split Type:
Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel. |
