VAERS ID: |
380464 (history) |
Form: |
Version .0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 2010-01-18 |
Onset: | 2010-01-19 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2010-02-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3564AA / 1 |
UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D67170 / 1 |
UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0574Y / 1 |
- / PO |
Administered by: Private Purchased by: Private Symptoms: Barium enema,
Intussusception,
Ultrasound abdomen abnormal SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (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: Vomited twice day prior and once this morning Preexisting Conditions: None Allergies: Diagnostic Lab Data: abd u/s positive with intussusception CDC Split Type:
Write-up: Intussusception on 1-19-10. Had Barium enema and it resolved. |