| VAERS ID: |
337061 (history) |
| Form: |
Version .0 |
| Age: |
0.4 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2008-12-10 |
| Onset: | 2009-01-08 |
| Days after vaccination: | 29 |
| Submitted: |
2009-01-12 |
| Days after onset: | 4 |
| Entered: |
2009-01-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B138BA / 1 |
LL / UN |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF242AB / 1 |
RL / UN |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
C87340 / 1 |
LL / UN |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1032X / 1 |
- / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal X-ray,
Abdominal distension,
Abdominal pain,
Constipation,
Crying,
Enema administration,
Hypophagia,
Intussusception,
Lethargy,
Metabolic function test normal,
Occult blood negative,
Ultrasound abdomen abnormal,
X-ray abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC Split Type:
Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home |
