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This is VAERS ID 264467

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 264467 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Kentucky  
Vaccinated:2006-09-01
Onset:2006-09-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2006-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR U1397AB / 1 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE930AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR X1166 / 1 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08683E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Haematochezia, Intestinal ischaemia, Intussusception, Necrosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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, 5 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initial exam showed blood stools, intussusception. DC DX: Intussusception. Procedure: exp. lap. with reduction of intussuception and right hemicolectomy. Taken emergently to operating room after water-soluble contrast enema was unable to reduce intussusception. Currant jelly stools starting at 8am on 9/17/06. Mass palpable at the midline of her abdomen. Hospital course uneventful, developed rash thought to be due to Unasyn, changed to Clindamycin. Surgical pathology report: sections show extensive ischemic necrosis secondary to intussusception. Appendiceal nucosa also shows ischemic necrosis. The amount of lymphoid tissue appears to be increased. Resected margins contain viable tissue.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=264467


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