VAERS ID: |
524961 (history) |
Form: |
Version .0 |
Age: |
0.2 |
Gender: |
Female |
Location: |
Mississippi |
Vaccinated: | 2014-02-26 |
Onset: | 2014-03-01 |
Days after vaccination: | 3 |
Submitted: |
2014-03-06 |
Days after onset: | 5 |
Entered: |
2014-03-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
7537C / 0 |
- / - |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UH997AA / 0 |
- / - |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
H00137 / 0 |
- / - |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB401A / 0 |
- / PO |
Administered by: Private Purchased by: Public Symptoms: Enema administration,
Intussusception,
Rash SMQs:, Anaphylactic reaction (broad), Gastrointestinal obstruction (narrow), Hypersensitivity (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: No Preexisting Conditions: No Allergies: Diagnostic Lab Data: Done in ED CDC Split Type:
Write-up: Intussusception 3/1 - 3/2/ 2014. Enema reduction. ? Rash on the face 24 hours after vaccine. Resolved in 2 days. |