| VAERS ID: |
405245 (history) |
| Form: |
Version .0 |
| Age: |
0.6 |
| Gender: |
Male |
| Location: |
California |
| Vaccinated: | 2010-07-12 |
| Onset: | 2010-10-03 |
| Days after vaccination: | 83 |
| Submitted: |
2010-10-25 |
| Days after onset: | 22 |
| Entered: |
2010-10-25 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3622AA / 2 |
RL / IM |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBVB789AA / 2 |
LL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
E49136 / 1 |
LL / IM |
| ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41DB056A / 2 |
- / PO |
Administered by: Public Purchased by: Public
Symptoms: Abdominal X-ray,
Asthenia,
Blood culture negative,
Constipation,
Enema administration,
Intussusception,
Irritability,
Ultrasound abdomen abnormal,
Vomiting,
X-ray abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: ABDOMINAL ULTRASOUND
CDC Split Type:
Write-up: RECEIVED REPORT STATING PT WAS DIAGNOSED WITH ILEOCOLIC INTUSSUSCEPTION REDUCED AT HOSPITAL |
