| VAERS ID: |
450583 (history) |
| Form: |
Version 1.0 |
| Age: |
0.36 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2011-12-30 |
| Onset: | 2012-01-23 |
| Days after vaccination: | 24 |
| Submitted: |
2012-02-27 |
| Days after onset: | 35 |
| Entered: |
2012-02-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3979AA / 2 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
91621 / 2 |
LL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41CB206A / 2 |
MO / PO |
Administered by: Unknown Purchased by: Public
Symptoms: Abdominal pain,
Intussusception,
Ultrasound abdomen,
Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
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: Topical steroid Nystatine topical
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ABDOMINAL US
CDC Split Type:
Write-up: TAKEN TO ER FOR ABDOMINAL PAIN AND EMESIS. DIAGNOSIS: INTUSSUSCEPTION. | 