VAERS ID: |
528141 (history) |
Form: |
Version .0 |
Age: |
0.2 |
Gender: |
Female |
Location: |
Oklahoma |
Vaccinated: | 2014-03-24 |
Onset: | 2014-03-29 |
Days after vaccination: | 5 |
Submitted: |
2014-04-10 |
Days after onset: | 12 |
Entered: |
2014-04-11 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
22J73 / 0 |
LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
J013944 / 0 |
LL / UN |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
H06568 / 0 |
RL / UN |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41CB405A / 0 |
- / PO |
Administered by: Public Purchased by: Public Symptoms: Barium enema abnormal,
Intussusception SMQs:, Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Ischaemic colitis (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, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Radiology suite confirmed ileocolic intuss. via barium enema CDC Split Type:
Write-up: Patient had routine 2-mo immunizations on 3/24/14 -$g admitted to hospital for intussusception on 3/29/14 and treated successfully via barium enema. |