|
| VAERS ID: |
286077 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2007-04-05 |
| Onset: | 2007-05-21 |
| Days after vaccination: | 46 |
| Submitted: |
2007-07-26 |
| Days after onset: | 66 |
| Entered: |
2007-07-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
U1985BA / 1 |
UN / IM |
| HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. |
0507F / 1 |
UN / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
Z0548 / 1 |
UN / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
8362584 / 1 |
UN / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1239F / 1 |
MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal X-ray,
Barium double contrast,
Barium enema,
Intussusception
SMQs:, 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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC Split Type:
Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. |
|
| VAERS ID: |
286188 (history) |
| Form: |
Version 1.0 |
| Age: |
0.5 |
| Sex: |
Male |
| Location: |
New Jersey |
| Vaccinated: | 2007-03-24 |
| Onset: | 2007-07-22 |
| Days after vaccination: | 120 |
| Submitted: |
2007-07-27 |
| Days after onset: | 5 |
| Entered: |
2007-07-30 |
| Days after submission: | 3 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1239F / 3 |
UN / UN |
Administered by: Other Purchased by: Other
Symptoms: Enema administration,
Intussusception
SMQs:, Gastrointestinal obstruction (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray - IT corrected 8/27/07-records received-Xray KUB: stool filled colon. US abdomen: RUQ intussusception. Fluoroscopically guided air enema reduced intussusception. PMH: pylonmyotomy at 5 weeks for pyloric stenosis. Labs: neutrophils 71.0, lymphs 18.0, glucose 112, total bilirubin 0.9.
CDC Split Type: WAES0707USA04056
Write-up: Information has been received from a registered nurse concerning a 10-month-old male who on 13-NOV-2006, 12-JAN-2007, and 24-MAR-2007 was vaccinated with the first, second, and third doses of Rotateq. On 22-JUL-2007 the patient experienced intussusception and was hospitalized. The intussusception was corrected with a barium enema and the child was released from the hospital. The patient recovered. No other information was available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 8/27/07-records received for DOS-7/22/07-DX: Intussusception. Reduced with Barium enema. C/O abdominal pain since toady 7/22/07-Cranky, crying, waking up. No fever. No vomiting. No diarrhea. No rash. |
|
| VAERS ID: |
286241 (history) |
| Form: |
Version 1.0 |
| Age: |
0.5 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2007-01-22 |
| Onset: | 2007-07-11 |
| Days after vaccination: | 170 |
| Submitted: |
0000-00-00 |
| Entered: |
2007-07-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC01B084CA / 3 |
- / IM |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
42260AA / 1 |
- / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08672K / 3 |
- / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1110F / 3 |
MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Discomfort,
Enema administration,
Haematochezia,
Intussusception,
Surgery,
Ultrasound abdomen abnormal,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC Split Type:
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced. |
|
| VAERS ID: |
286278 (history) |
| Form: |
Version 1.0 |
| Age: |
0.18 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2007-05-31 |
| Onset: | 2007-07-09 |
| Days after vaccination: | 39 |
| Submitted: |
2007-07-26 |
| Days after onset: | 17 |
| Entered: |
2007-07-31 |
| Days after submission: | 5 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B101AA / 1 |
UN / UN |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0205U / 1 |
UN / UN |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08690A / 1 |
UN / UN |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0407U / 1 |
MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Inappropriate schedule of drug administration,
Intussusception,
Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis.
CDC Split Type: WAES0707USA02866
Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted |
|
| VAERS ID: |
286279 (history) |
| Form: |
Version 1.0 |
| Age: |
0.5 |
| Sex: |
Male |
| Location: |
Pennsylvania |
| Vaccinated: | 2007-01-03 |
| Onset: | 2007-06-05 |
| Days after vaccination: | 153 |
| Submitted: |
2007-07-26 |
| Days after onset: | 51 |
| Entered: |
2007-07-31 |
| Days after submission: | 5 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
ACZ1B04CA / 3 |
LL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
1508670R / 3 |
RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1034F / 3 |
MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Barium enema,
Enema administration,
Intussusception,
Surgery,
X-ray
SMQs:, Gastrointestinal obstruction (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? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the rectum.
CDC Split Type: WAES0707USA03817
Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception. |
|
| VAERS ID: |
286408 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2007-05-11 |
| Onset: | 2007-07-25 |
| Days after vaccination: | 75 |
| Submitted: |
2007-07-31 |
| Days after onset: | 6 |
| Entered: |
2007-08-01 |
| Days after submission: | 1 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
- / UNK |
UN / UN |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
- / UNK |
UN / UN |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
- / UNK |
UN / UN |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0029U / 2 |
UN / UN |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
SMQs:, 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, 5 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC Split Type: WAES0707USA04584
Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool. |
|
| VAERS ID: |
286490 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
2007-08-01 |
| Entered: |
2007-08-02 |
| Days after submission: | 1 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (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? Yes, 0 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0707USA04032
Write-up: Information has been received from a physician concerning a female patient who was vaccinated with a dose of Rotateq. Subsequently "after the fourth month dose" the patient experienced intussusception and was hospitalized. It was reported that the patient was in the hospital but the length of stay was not provided. On an unspecified ate, the patient recovered. No product quality complaint was involved. Additional information has been requested. |
|
| VAERS ID: |
286493 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Sex: |
Male |
| Location: |
Mississippi |
| Vaccinated: | 2007-04-03 |
| Onset: | 2007-06-01 |
| Days after vaccination: | 59 |
| Submitted: |
2007-08-01 |
| Days after onset: | 61 |
| Entered: |
2007-08-02 |
| Days after submission: | 1 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B090AA / 1 |
LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0658F / 1 |
RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08681D / 1 |
RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1232F / 1 |
MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception,
Surgery
SMQs:, Gastrointestinal obstruction (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown Birth HX: preterm 37.5 wks. jaundice.
Allergies:
Diagnostic Lab Data: Unknown LABS: CT of head in ER was WNL. KUB in ER revealed obstruction. Abdominal x-ray. UGI showed poor peristalsis. Water soluble BE revealed ileocolic IS, only partially reduced.
CDC Split Type: WAES0707USA03737
Write-up: Information has been received from a physician concerning an approximately 5 month old male who on 05-APR-2007 was vaccinated orally with a 2 ml dose of Rotateq (lot# 656192/0022U). Subsequently, the patient experienced intussusception, was hospitalized and released after surgery. On an unspecified ate, the patient recovered. No product quality complaint was involved. A lot check was requested. Intussusception was considered to be immediately life-threatening and an other important medical event. Additional information has been requested. 9/11/07 Reviewed pcp medical records & vax records which corrected vax lot #. VAERS database updated w/same. Records reveal patient experienced good health w/sneezing, pinpoint facial rash & colic. Hospitalized 6/1-6/6 for intestinal polyp surgery. Received 2nd dose RO on 6/21. 3rd dose held. 9/25/07 Reviewed hospital medical records which reveal patient experienced bilious emesis on day of admit 6/2-6/6/2007 followed by coffee grounds emesis & bloody stool. Seen at outside ER & transferred for higher level of care. Upon admit was lethargic, abdomen soft & nondistended & no mass palpable. To OR for exp laparotomy & reduction of ileocolonic IS. Did well post op & d/c to home when tolerating oral feeds & having stool. FINAL DX: Ileocolonic Intussusception, surgically reduced. 9/25/07 pcp medical records & vax record faxed to CDC. |
|
| VAERS ID: |
286500 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Sex: |
Female |
| Location: |
Virginia |
| Vaccinated: | 2007-06-01 |
| Onset: | 2007-06-17 |
| Days after vaccination: | 16 |
| Submitted: |
2007-07-31 |
| Days after onset: | 44 |
| Entered: |
2007-08-02 |
| Days after submission: | 2 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC148056BA / 2 |
LL / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF100AA / 2 |
LL / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
Z0548 / 2 |
RL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
BO869OC / 2 |
LL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1365F / 3 |
MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Intussusception,
Surgery
SMQs:, Gastrointestinal obstruction (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? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: BE unsuccessful. Abdominal x-ray revealed probable IS. Urine, blood, stool c/s neg. Stool for rotavirus neg.
CDC Split Type:
Write-up: Infant received ROTATEQ 2nd dose on 6/1/07; on 6/17/07diagnosed and operated on for intussusception in hospital. 8/3/07 Received vax record which provided RO lot # 1365F & dose #2. Prevnar Lot # should be B08690C. Database updated w/same. 8/28/07 Received hospital medical records from CDC which reveal patient experienced vomiting & bloody stool x 1 day. Admitted 6/17-6/19/07. BE diagnosed IS but unable to reduce. To OR for reduction of ileocolic IS & appendectomy. Progressed well post op. FINAL DX: Ileocolic IS, surgical reduction. |
|
| VAERS ID: |
286563 (history) |
| Form: |
Version 1.0 |
| Age: |
0.4 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2007-05-29 |
| Onset: | 2007-07-11 |
| Days after vaccination: | 43 |
| Submitted: |
2007-08-02 |
| Days after onset: | 22 |
| Entered: |
2007-08-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B097AB / 2 |
RL / IM |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
00710 / 2 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08679C / 2 |
LL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0695F / 2 |
MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Enema administration,
Intussusception,
Surgery
SMQs:, Gastrointestinal obstruction (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: intussception~Rotavirus (Rotateq)~2~0.40~In Patient
Other Medications:
Current Illness: No
Preexisting Conditions: None PMH: eczema.
Allergies:
Diagnostic Lab Data: Air enema documenting intussusception Hospital LABS: WBC 18.3, neutros 65, lymphs 29. Chemistry WNL. Blood & urine c/s neg. CXR WNL. Abdominal x-ray revealed IS. Air enema revealed ileocolic intussusception, unable to reduce. Post op KUB was WNL.
CDC Split Type:
Write-up: Patient Received Rotavirus vaccine (along with DTaP, Hep B, IPV, HiB, Prevnar) on 5/29/07. On 7/11/07, she presented to the ED and was diagnosed with intussusception. Did not resolve with air enema. Required surgical reduction. 8/21/07 Received hospital medical records which reveal patient experienced nausea, vomiting & bloody stools x 1 day. Admitted 7/11-7/15/07. X-ray revealed IS & air enema failed to reduce. Taken to OR for exp laparotomy. Patient did well post op & d/c to home. FINAL DX: Intussusception, s/p surgical reduction. 8/21/07 Received clinic records including vax records which confirm RO dose & lot as reported. Patient w/runny nose & cough on day of vax. RTC 6/5 w/fever, runny nose, cough. Dx: viral syndrome. 7/23 f/u visit post op for vomiting, cranky, cough, fever. DX: viral syndrome & possible UTI. |
|
