| VAERS ID: |
462749 (history) |
| Form: |
Version .0 |
| Age: |
0.18 |
| Gender: |
Female |
| Location: |
Connecticut |
| Vaccinated: | 2012-08-07 |
| Onset: | 2012-08-12 |
| Days after vaccination: | 5 |
| Submitted: |
2012-08-14 |
| Days after onset: | 2 |
| Entered: |
2012-08-22 |
| Days after submission: | 8 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C419AA / 0 |
RL / UN |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBVC093AA / 1 |
LL / UN |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
918242 / 0 |
LL / UN |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB268A / 0 |
- / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium enema abnormal,
Enema administration,
Haematochezia,
Intussusception,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)
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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Intussusception diagnosed at hospital 8/12/12. Reduced by barium enema at hospital. S/p vomiting & bloody stools. |
