| VAERS ID: |
385949 (history) |
| Form: |
Version .0 |
| Age: |
0.2 |
| Gender: |
Male |
| Location: |
Nebraska |
| Vaccinated: | 2010-03-01 |
| Onset: | 2010-04-24 |
| Days after vaccination: | 54 |
| Submitted: |
2010-04-26 |
| Days after onset: | 2 |
| Entered: |
2010-04-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3606AA / 0 |
UN / IM |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBVB772CA / 1 |
UN / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
E20366 / 0 |
UN / IM |
| ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41DB036A / 0 |
- / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception
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? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: intussusception~Rotavirus (Rotarix)~1~0.00~Patient
Other Medications: PRILOSEC 1 ml BID (2mg/ml)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Fluoro Barium Enema and ultra sound
CDC Split Type:
Write-up: Infant was admitted to hospital with intussusception on 4/24/10. | 