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This is VAERS ID 265451

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

Case Details

VAERS ID: 265451 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Nebraska  
Vaccinated:2006-10-11
Onset:2006-10-14
   Days after vaccination:3
Submitted: 2006-10-26
   Days after onset:12
Entered: 2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Platelet count increased, Pyrexia, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admi
CDC Split Type:

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital (Columbus) prior to admission to Children''s on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per Hector I. (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


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