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 |