| VAERS ID: |
527969 (history) |
| Form: |
Version 1.0 |
| Age: |
0.17 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2014-02-25 |
| Onset: | 2014-04-02 |
| Days after vaccination: | 36 |
| Submitted: |
2014-04-08 |
| Days after onset: | 6 |
| Entered: |
2014-04-09 |
| Days after submission: | 1 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
7449K / 1 |
LL / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UH973AA / 1 |
RL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
G98652 / 1 |
RL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB414A / 1 |
MO / PO |
Administered by: Private Purchased by: Public
Symptoms: Diarrhoea haemorrhagic,
Intussusception,
Irritability,
Surgery,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness:
Preexisting Conditions: Apnea; GERD; RSV Bronchitis
Allergies:
Diagnostic Lab Data: Intussusception / Surgery
CDC Split Type:
Write-up: Vomiting, bloody diarrhea, fussy. |
