VAERS ID: |
403352 (history) |
Form: |
Version .0 |
Age: |
0.4 |
Gender: |
Female |
Location: |
Missouri |
Vaccinated: | 2010-08-10 |
Onset: | 2010-08-31 |
Days after vaccination: | 21 |
Submitted: |
2010-10-14 |
Days after onset: | 44 |
Entered: |
2010-10-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B187AA / 1 |
RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0235Z / 1 |
LL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
E52353 / 1 |
LL / IM |
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41DB058A / 0 |
- / PO |
Administered by: Private Purchased by: Other Symptoms: Abdominal distension,
Colectomy,
Ileectomy,
Intussusception,
Surgery,
Ultrasound scan abnormal,
Vomiting SMQs:, Acute pancreatitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
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, 6 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: had ultrasound and then surgery CDC Split Type:
Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010. |