| VAERS ID: |
444118 (history) |
| Form: |
Version .0 |
| Age: |
0.17 |
| Gender: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2011-10-24 |
| Onset: | 2011-10-31 |
| Days after vaccination: | 7 |
| Submitted: |
2011-11-14 |
| Days after onset: | 14 |
| Entered: |
2011-11-30 |
| Days after submission: | 16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B305AA / 0 |
LL / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1189AA / 0 |
RL / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
F08531 / 0 |
LL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB2269 / 0 |
- / PO |
Administered by: Private Purchased by: Public
Symptoms: Intussusception,
Ultrasound abdomen abnormal,
Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
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, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Concern of increased spit up.
Allergies:
Diagnostic Lab Data: Intussusception.
CDC Split Type:
Write-up: Went to ER with severe vomiting. Ultrasound found intussusception. | 