| VAERS ID: |
456491 (history) |
| Form: |
Version .0 |
| Age: |
0.34 |
| Gender: |
Female |
| Location: |
Tennessee |
| Vaccinated: | 2012-02-28 |
| Onset: | 2012-03-22 |
| Days after vaccination: | 23 |
| Submitted: |
2012-05-30 |
| Days after onset: | 69 |
| Entered: |
2012-05-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B315DA / 1 |
RL / IM |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1189AA / 1 |
LL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
F22722 / 1 |
LL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41B226A / 1 |
- / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium enema,
Crying,
Culture stool,
Full blood count,
Haematochezia,
Intussusception,
Metabolic function test,
Occult blood,
X-ray
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (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, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CBC; CMP; Stool culture; stool occult blood; XR; Barium enema - reduced intussusception
CDC Split Type:
Write-up: Admitted 03/23/12, inconsolable crying and bloody stools x 3 days. GI consult. |
