| VAERS ID: |
409111 (history) |
| Form: |
Version .0 |
| Age: |
0.8 |
| Gender: |
Male |
| Location: |
Indiana |
| Vaccinated: | 2010-10-05 |
| Onset: | 2010-10-19 |
| Days after vaccination: | 14 |
| Submitted: |
2010-11-17 |
| Days after onset: | 29 |
| Entered: |
2010-11-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / - |
UN / UN |
Administered by: Other Purchased by: Other
Symptoms: Barium double contrast,
Decreased appetite,
Diarrhoea,
Haematochezia,
Intussusception,
Somnolence,
Surgery,
Urinary system X-ray,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB, contrast enema
CDC Split Type:
Write-up: Presented to ER on 10/19/2010 with vomiting, anorexia, somnolence, and loose bloody stools. Irreducible ileocolonic intussusception noted with contrast enema. Surgical reduction was required. |
