VAERS ID: |
450583 (history) |
Form: |
Version 1.0 |
Age: |
0.36 |
Gender: |
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. |