| VAERS ID: |
502837 (history) |
| Form: |
Version 1.0 |
| Age: |
0.17 |
| Gender: |
Female |
| Location: |
Maine |
| Vaccinated: | 2013-09-05 |
| Onset: | 2013-09-11 |
| Days after vaccination: | 6 |
| Submitted: |
2013-09-17 |
| Days after onset: | 6 |
| Entered: |
2013-09-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C4452AA / 1 |
LL / IM |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
H017304 / 2 |
RL / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UH807AA / 1 |
LL / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
J1281 / 1 |
LL / SC |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
G43220 / 1 |
RL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB344A / 1 |
MO / PO |
Administered by: Private Purchased by: Public
Symptoms: Enema administration,
Intussusception
SMQs:, Gastrointestinal obstruction (narrow)
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, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema reduced
CDC Split Type:
Write-up: Intussusception 5 days after ROTARIX. | 