| VAERS ID: |
523871 (history) |
| Form: |
Version .0 |
| Age: |
0.2 |
| Sex: |
Female |
| Location: |
Louisiana |
| Vaccinated: | 2014-02-18 |
| Onset: | 2014-02-21 |
| Days after vaccination: | 3 |
| Submitted: |
2014-02-24 |
| Days after onset: | 3 |
| Entered: |
2014-02-25 |
| Days after submission: | 1 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
7449K / - |
RL / IM |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
J011112 / - |
LL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
G98915 / - |
LL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB389A / - |
- / PO |
Administered by: Private Purchased by: Public
Symptoms: Enema administration,
Haematochezia,
Intussusception,
Mental status changes,
Urinary system X-ray,
X-ray abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Cardiomyopathy (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, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: KUB (+) intussusception; Reduced by air enema x2.
CDC Split Type:
Write-up: 10 m/o presented to ED with c/o altered mental status on 2/21. KUB 2/22 showed intussusception. Bloody stools x 2, refusal of PO. |
