| VAERS ID: |
386671 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Male |
| Location: |
Washington |
| Vaccinated: | 2010-04-14 |
| Onset: | 2010-04-28 |
| Days after vaccination: | 14 |
| Submitted: |
2010-05-04 |
| Days after onset: | 6 |
| Entered: |
2010-05-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C3556AA / 3 |
LL / UN |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
AHBVB818AA / 3 |
RL / UN |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
E45349 / 3 |
RL / UN |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1213Y / 3 |
MO / PO |
Administered by: Private Purchased by: Other
Symptoms: Barium enema,
Blood test,
Intussusception,
Ultrasound abdomen,
Vomiting,
X-ray
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, x-ray, - Barium enema, abd. US
CDC Split Type:
Write-up: Intussusception, emesis went to hospital ER on 4/28/2010. Treatment: IV hydration, ZOFRAN, PEPCID. |
