VAERS ID: |
435399 (history) |
Form: |
Version .0 |
Age: |
0.3 |
Gender: |
Male |
Location: |
Rhode Island |
Vaccinated: | 2011-09-16 |
Onset: | 0000-00-00 |
Submitted: |
2011-09-22 |
Entered: |
2011-09-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B277AB / 0 |
UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0254DA / 0 |
UN / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
916007 / 0 |
UN / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
A41FB159A / 0 |
- / PO |
Administered by: Private Purchased by: Other Symptoms: Intussusception SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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, 1 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: None Current Illness: Stuffy nose; Cough Preexisting Conditions: No Allergies: Diagnostic Lab Data: ? was in ER CDC Split Type:
Write-up: Intussusception on (9/20/2011). |