| VAERS ID: |
427945 (history) |
| Form: |
Version 1.0 |
| Age: |
0.28 |
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 2011-04-29 |
| Onset: | 2011-05-03 |
| Days after vaccination: | 4 |
| Submitted: |
2011-07-22 |
| Days after onset: | 80 |
| Entered: |
2011-07-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3542AA / 1 |
LL / IM |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBVB842AA / 1 |
RL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
916302 / 1 |
RL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41DB154A / 1 |
MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal X-ray,
Abdominal mass,
Crying,
Induration,
Intussusception,
Irritability,
Pain,
Screaming,
Stomach mass,
Ultrasound abdomen abnormal,
Vomiting,
X-ray abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)
Life Threatening? Yes
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:
Current Illness: Slight cold, we had delayed shots for about 2 weeks before due to having a cold
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Started with a painful fit and finally pushed out a bowel movement. After that the fierce vomiting and painful squeals about every 30-45 minutes. Pt could not keep anything down even for seconds after having them. At around 9am I noticed a larger lump in her sunken stomach that felt very hard. Was headed to hospital when pediatrician called and requested to go to his office instead of emergency room. Saw him at 2 and the vomitting had continued until bile. Saw the Pediatrician and he sent us to Childrens health care. There we had an x-ray and then an ultrasound to conclude it was intussusception. |
