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Found 753 cases where Vaccine is RV5 and Symptom is Intussusception and Appearance Date on/before '2012-04-30'

Case Details

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VAERS ID: 353133 (history)  
Form: Version 1.0  
Age: 0.24  
Gender: Female  
Location: New Jersey  
Vaccinated:2009-07-09
Onset:2009-07-20
   Days after vaccination:11
Submitted: 2009-08-04
   Days after onset:15
Entered: 2009-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3142AA / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0148Y / 1 MO / PO

Administered by: Private       Purchased by: Private
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? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 8/31/09 Hospital records received DOS 7/20/09 to 7/28/09. LABS and DIAGNOSTICS: EEG - WNL. CT Scan Head - Enlargement of subarachnoid spaces. Ultrasound Abdomen - Abnormal, Ileocolic intussusception. X-ray - Abdomen - Small bowel obstruction with intussusception. Surgical Pathology - Abnormal, consistant with intussusception. CBC - RBC 2.71 per mm3 (L) Hgb 8.2 gram/dL (L) Hct 23.5% (L) MCV 86.8 fL (H) Platelet Count 559 per mm3 (H) Bands 8.0% (H) Lymphocytes 38.0% (L) Monocytes 11.0% (H) Basophils 0.0% (L). ABS Lymphocytes 3.00 per mm3 (L) ABS Monocytes 0.87 (H). CHEM - Glucose 85 mg/dL (H) BUN 3 mg/dL (L) Creatinine 0.20 mg/dL (L) Potassium 6.4 mmol/L (H) Albumin 3.6 gram/dL (L) AST 40 U/L (H) Creatine Kinase 145.0 U/L (H) CK MB Fraction 5.7 ng/mL (H). CSF - WNL. Urinalysis - WNL. Urine culture - no growth. Blood cultures - no growth.
CDC Split Type:

Write-up: Intussusception 7/20/09 - symptoms began. Required surgical reduction 7/22/09. 8/31/09 Hospital records received DOS 7/20/09 to 7/28/09. Assessment: Intussusception. Infant had increased sweating, drowsy, pale, not arousable or responding. having tremors all 4 limbs and shaking. Decreased urine output. Projectile vomiting decreased appetite. Dehydration. Greenish mucousy stools. Fever. Barium enema reduction unsuccessful. Laparotomy, ileocectomy, ileo ascending colostomy anastomosis.


VAERS ID: 354036 (history)  
Form: Version 1.0  
Age: 0.54  
Gender: Male  
Location: Missouri  
Vaccinated:2009-07-22
Onset:2009-08-03
   Days after vaccination:12
Submitted: 2009-08-12
   Days after onset:9
Entered: 2009-08-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3294AB / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1450X / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium double contrast, Constipation, Enema administration, Haematochezia, Hypophagia, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none 10/02/09 Medical records received w/PMH: 41 Preemie, hospitalized with r/o sepsis; eczema
Allergies:
Diagnostic Lab Data: Air contrast enema - reduced transverse colon intussusception 10/2/09 Medical records received w/LABS: stool guiaic (+). Abdominal x-ray (+)IS. Air contrast enema successfully reduced. Stool c/s neg.
CDC Split Type:

Write-up: Intussusception. Vaccine give 7/22/09, 8/3/09 - decreased p.o intake, vomiting, temp 99.8. 8/5/09 - persistent vomiting, no stool --$g to Emergency Room where bloody stool occurred. Air contrast enema relived an intussusception. 10/02/09 Received hospital medical records for 8/5/09-8/6/20009. FINAL DX: Intussusception, enema reduced Records reveal patient experienced vomiting x 2 days, mucous dark red stool, fever, drawing up legs, no urine output x 1 day, irritability, lethargic. Surgical consult done. Admitted for observation s/p enema reduction of IS. ICD9 codes: 5600.


VAERS ID: 354738 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Colorado  
Vaccinated:2009-08-06
Onset:2009-08-13
   Days after vaccination:7
Submitted: 2009-08-14
   Days after onset:1
Entered: 2009-08-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B173AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF568AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46875 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0572Y / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal mass, Barium enema abnormal, Diarrhoea haemorrhagic, Enema administration, Haemoglobin normal, Intussusception, Pain, Ultrasound scan abnormal, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Milk protein intolerance
Allergies:
Diagnostic Lab Data: Ultrasound suggestive of intussusception. Contrast enema diagnosed/reduced intussusception. WBC 20.9
CDC Split Type:

Write-up: Pt had vomiting, bloody diarrhea. Seen in ER. Seemed to be in pain - bright red blood in diaper, mass palpable in abdomen. Ultrasound suspicious for intussusception. Contrast enema diagnosed/reduced intussusception. Pt had enema within approx 5 hours of start of symptoms. Hospitalized overnight. Hgb stable. 10/14/09 ICD-9 Codes received: 560.0 Intussusception.


VAERS ID: 355134 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Tennessee  
Vaccinated:2009-06-12
Onset:2009-06-28
   Days after vaccination:16
Submitted: 2009-08-21
   Days after onset:54
Entered: 2009-08-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B123AA / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D46874 / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0039Y / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema reduced intussusception. 9/1/09 Hospital records received DOS 6/28/09 to 6/29/09. LABS and DIAGNOSTICS; CBC - WBC 14.7 TH/MM3 (H) PLT 552 TH/MM3 (H) MON 4.0% (L) Neut 10.90 TH/MM3 (H). CHEM - Glucose 152 MG/DL (H) AST 40 U/L (H).Amylase/Lipase - Normal. Urinalysis - Cloudy, ketones (+) Albumin (+). Blood Culture (-). Abdominal X-ray - Abnormal.
CDC Split Type:

Write-up: Intussusception 2 wks after receiving 2nd ROTATEQ. 9/1/09 Hospital records received DOS 6/28/09 to 6/29/09. Assessment: Intussusception. Patient presents with acute onset of vomiting, bilious. Vomited 17 times. PO intake decreased, decreased wet diapers. Red colored urine. Dark green stool. Fussy. Fever, malaise, fatigue. Dry lips and mouth. Dehydration. Barium Enema administration with reduction of intussusception. 10/2/09 ICD-9 Codes: 560.0 Instussusception, 780.79 Malaise and Fatigue, 780.60 Fever, 787.03 Vominting w/o nausea.


VAERS ID: 355828 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: New Jersey  
Vaccinated:2009-08-04
Onset:2009-08-10
   Days after vaccination:6
Submitted: 2009-08-27
   Days after onset:17
Entered: 2009-08-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown. 9/22/09 Hospital records received DOS 8/13/09 to 8/22/09. LABS and DIAGNOSTICS: Chest X-ray -Abnormal. Abdominal X-ray - Abnormal. Barium enema - Abnormal. US Abdomen - Abnormal. CBC - WBC 5.2 per mm3 (L) RBC 3.18 per mm3 (L) Hgb 8.7 gm/dL (L) Hct 26.2% (L) Neut 53.8% (H) Lymph 40.5 (L) Baso 0.4% ABS Neut 3.02 per mm3 (L) ABS Lymph 1.14 per mm3 (L). Urinalysis - Turbid, ketones 15 mg/dL (H), bacteria, crystals. Urine Culture Yeast (+). CHEM - C-Reactive Protein 163.0 mg/L (H) Glucose 153 mg/dL (H) Creatinine 0.20 mg/dL (L) BUN 3 mg/dL (L) Potassium 7.3 mmol/L (H) Protein 3.5 gram/dL (L) Albumin 1.6 gram/dL (L) ALT 20 U/L (L) Alk Phos 63 U/L (L) Phosphorus 1.4 mg/dL (L).
CDC Split Type: WAES0908USA03925

Write-up: Information has been received from a physician concerning a 6 months old male who on 04-AUG-2009 was vaccinated with the third dose of ROTATEQ (route and lot# not reported). On 10-AUG-2009 the patient developed intussusceptions. The patient required surgery. At the time of the report, the patient''s outcome was unknown. Upon internal review, intussusception was determined to be an other important medical event. Additional information has been requested. 9/22/09 Hospital records received DOS 8/13/09 to 8/22/09. Assessment: Ileo-Colic Intussusception. Patient presented with history of bilious vomiting and abdominal pain. Lethargic, dry mucous membranes and skin. Dehydration. No bowel sounds. Abdominal mass. Respiratory distress. Barium Enema administration - unsuccessful reduction of intussusception. Surgical resection of intussusception, ileocolectomy with ilial transverse colostomy. 10/5/09 ICD-9 Codes: 751.5 Intestinal anomaly, 038.9 Septicemia NOS, 995.92 Severe Sepsis, 518.81 Acute Respiratory Fail, 785.52 Septic Shock, 285.9 Anemia NOS.


VAERS ID: 355829 (history)  
Form: Version 1.0  
Age: 0.17  
Gender: Male  
Location: Tennessee  
Vaccinated:2009-06-25
Onset:2009-08-05
   Days after vaccination:41
Submitted: 2009-08-27
   Days after onset:22
Entered: 2009-08-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 03000AA / 2 LL / IJ
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 2 RL / IJ
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 040097 / 2 LL / IJ
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0285Y / 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, 2 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown. 9/8/09 Hospital records received DOS 8/3/09 to 8/5/09. LABS and DIAGNOSTICS: Urine culture (-). Urinalysis - Ketones 1+. Stool occult blood (+) WBC (+). KUB X-ray - Abnormal. Abdominal Ultrasound - Abnormal. CHEM - Sodium 134 Potassium 5.0 Chloride 102 CO2 21 BUN 12 creatinine 0.23. CBC - WBC 5.5 (L) Hemoglobin 10.6 Hematocrit 32.1 (L) Platelet Count 132 (L). Stool Cultures (-).
CDC Split Type: WAES0908USA04230

Write-up: Information has been received from a medical assistant concerning an 8 weeks old male patient who on 25-JUN-2009 was vaccinated with a first dose of ROTATEQ (2ml, orally and lot number: 663461/085Y). Concomitant therapy included DTaP, ACTHIB, PREVNAR (dates, doses and lot numbers not reported). On 05-AUG-2009 the child was hospitalized with intussusception and surgery performed. The child was released at the hospital at the next day (on 06-AUG-2009). At the time of the report the patient was recovered and an other important medical event. Intussusception was considered to be immediately life-threatening. Additional information has been requested. 9/8/09 Hospital records received DOS 8/3/09 to 8/5/09. Assessment: Intussusception. Patient presented with a one day history of vomiting and hematochezia. Bloody stool. Decreased activity, poor feeding. Projectile vomiting. Barium Enema - successful reduction. 10/13/09 ICD-9 Code: 560.0 Intussusception.


VAERS ID: 356185 (history)  
Form: Version 1.0  
Age: 0.36  
Gender: Female  
Location: Unknown  
Vaccinated:2009-07-28
Onset:2009-08-11
   Days after vaccination:14
Submitted: 2009-08-31
   Days after onset:20
Entered: 2009-09-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3296AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 063487 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015Y / 2 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: None Allergies: NKDA
Allergies:
Diagnostic Lab Data: Unknown Labs: CBC, Elevated wbc, paltelets and lymphs, LFT''s elevated Alt and Ast, blood and urine cultures neg, stool + for occult blood Dx studies: Abd US + intussusception, Barium enema
CDC Split Type: WAES0908USA04691

Write-up: Information has been received from a pediatric resident physician concerning an approximately 6 month old patient who on an unspecified date was vaccinated with a dose of ROTATEQ (lot # not reported) orally. On an unspecified date the patient was diagnosed with intussusception and on an unspecified date the patient was hospitalized. Intussusception outcome was unknown. Additional information has been requested. 11/10/2009 hospital records for 8/11-8/14/2009.DC DX Intussusception. patient with c/o''s fever, nausea, vomiting, abdominal pain, blood in stools, and lethargy. Abd Us + for intussusception which was reduced. Tx: IVF, IV ABX.


VAERS ID: 356256 (history)  
Form: Version 1.0  
Age: 0.34  
Gender: Female  
Location: New York  
Vaccinated:2009-08-14
Onset:2009-08-27
   Days after vaccination:13
Submitted: 2009-09-01
   Days after onset:5
Entered: 2009-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3230AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D21053 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0011Y / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intestinal resection, Intussusception
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. 9/14/09 Hospital records received DOS 8/27/09 to 8/31/09. Constipation. Cough. Noisy breathing.
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: Abdominal Sonogram - Abnormal. Abdominal X-ray - Abnormal. CHEM - Bicarbonate 20 mEq/L (L) Urea Nitrogen 17 mg/dL (H) Creatinine 0.2 mg/dL (L) CBC - Hemoglobin 8.8 g/dL (L) Hematocrit 25.6% (L) MCV 71.8 fL (L) Platelets 435.0 k/uL (H) Neutrophils 80% (H) Lymphocytes 18% (L) Neutrophil Count 11.0 k/uL (H) Lymphocyte count 2.4 k/uL (L) Eosinophil Count 0.0 k/uL (L)
CDC Split Type:

Write-up: Intussusception. Failed reduction. Required surgical resection. 9/14/09 Hospital records received DOS 8/27/09 to 8/31/09. Assessment: Intussusception. Infant presents with three days vomiting, poor oral intake, dehydration, diarrhea. On admission projectile vomiting. Blood tinged stool. Unable to reduce intussusception via air enema. Exploratory laparotomy, reducable intussusception, ileocecectomy. Initially febrile post-op, steadily improved, good po intake with return of bowel function. ICD-9 Codes: 580.0 Intussusception, 285.1 AC Posthemorrhagic anemia, 997.4 Digestive system complication, 560.1 Paralytic ileus, E878.8 Abn React-Surg Proc nec.


VAERS ID: 356992 (history)  
Form: Version 1.0  
Age: 0.46  
Gender: Female  
Location: New York  
Vaccinated:2009-08-25
Onset:2009-08-26
   Days after vaccination:1
Submitted: 2009-09-11
   Days after onset:16
Entered: 2009-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3428AB / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0890Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57303 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1485X / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Colectomy, Enema administration, Gastrointestinal necrosis, Haematochezia, Intensive care, Intussusception, Mucous stools, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 12/14/09 Received medical records w/PMH: Erb''s palsy, had recent Neuro eval.
Allergies:
Diagnostic Lab Data: She had a sonogram showing ileocolic intussusception which was not reducible with air enema. She went to the OR and was found to have necrotic bowel requiring right hemicolectomy. 10/15/09 Hospital records, DC summary received service dates 8/27/09 to 09/1/09. LABS and DIAGNOSTICS: KUB - Abnormal. Abdominal Ultrasound -abnormal, intussusception. CBC - RBC 3.12 x10 6/ul (L) Hemoglobin 8.4 G/DL (L) Hematocrit 25.0% (L) RDW 12.2% (L) Monocyte 25.5% (H) Monocyte 2.0 x10 3/uL (H). CHEM - Potassium 3.8 MEQ/L (L) Urea Nitrogen 3 MG/DL (L) Creatinine 0.2 MG/DL (L). Prothrombin time 15.8 sec (H). Barium enema - Abnormal.
CDC Split Type:

Write-up: Patient received vaccine on 8/25/09 and 2 days later she presented to the ED with emesis and currant jelly stools. She was found to have an intussusception which was not reducible by air enema. She went to the OR where the surgeons were unable to free the intussusception so she underwent a right hemicolectomy. She was hospitalized from 8/27-9/1. Four days were in the intensive care unit and the remainder were on the floor. 10/15/09 Hospital records, DC summary received service dates 8/27/09 to 09/1/09. Assessment: Intussusception s/p bowel resection. Parent states baby refuses to eat. Episodes of yellow emesis. Bright red blood per rectum w/o stool or urine. Decreased activity. Dehydration. Abdominal tenderness. Current jelly stool. Enema administration, reduction unsuccessful. Laparoscopic reduction of intussuseption converted to open right hemicolectomy. Ileocolic intussusception had intussuscepted into sigmoid colon, gangrene of cecum, serosal tears of proximal transverse colon with patchy necrosis. Patient stable upon discharge. 12/14/09 Received PCP medical records of 8/25/09 well child visit.


VAERS ID: 361034 (history)  
Form: Version 1.0  
Age: 0.48  
Gender: Male  
Location: Alabama  
Vaccinated:2009-06-19
Onset:2009-10-08
   Days after vaccination:111
Submitted: 2009-10-15
   Days after onset:7
Entered: 2009-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3287AA, C3153B / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D18704 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0011Y / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: eczema
Allergies:
Diagnostic Lab Data: 11/13/09 DC summary and ER records received for date 10/9/09 Diag/Labs: KUB(-), US abdomen (+) Intussusception.
CDC Split Type:

Write-up: intussusception 11/13/09 DC summary and ER records received for date 10/9/09. DX: Intussusception, abdominal pain, vomiting. Presented to ER w/ chief c/o vomiting, heart racing, lethargy. Emesis became bilious this day. Assessment: (+)abd pain, vomiting. Air contrast enema performed, successful reduction. Pt admitted for observation. ICD9 codes: 789.0, 787.03, 560.0.


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