| VAERS ID: |
531100 (history) |
| Form: |
Version .0 |
| Age: |
0.34 |
| Gender: |
Male |
| Location: |
Georgia |
| Vaccinated: | 2014-04-24 |
| Onset: | 2014-04-29 |
| Days after vaccination: | 5 |
| Submitted: |
2014-05-16 |
| Days after onset: | 17 |
| Entered: |
2014-05-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
ML5D7 / 1 |
LL / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UH832AB / 1 |
RL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
H45098 / 1 |
LL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB412A / 1 |
- / PO |
Administered by: Private Purchased by: Private
Symptoms: Crying,
Haematochezia,
Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Intussusception
CDC Split Type:
Write-up: Pt. mom states bloody stool, uncontrollable crying. | 