| VAERS ID: |
383135 (history) |
| Form: |
Version .0 |
| Age: |
0.5 |
| Gender: |
Male |
| Location: |
New York |
| Vaccinated: | 2010-03-15 |
| Onset: | 2010-03-19 |
| Days after vaccination: | 4 |
| Submitted: |
2010-03-22 |
| Days after onset: | 3 |
| Entered: |
2010-03-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3555AA / 1 |
LL / IM |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
AHBVB818BA / 3 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D94434 / 1 |
RL / IM |
| ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB036A / 1 |
- / PO |
Administered by: Private Purchased by: Public
Symptoms: Aspartate aminotransferase increased,
Barium double contrast,
Blood creatinine decreased,
Blood culture negative,
Carbon dioxide decreased,
Culture stool negative,
Diarrhoea,
Full blood count,
Haematemesis,
Haematocrit decreased,
Haemoglobin decreased,
Intussusception,
Metabolic function test,
Platelet count increased,
Pyrexia,
Red blood cell count decreased,
Stool analysis abnormal,
Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: intussusception |
