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This is VAERS ID 265698

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 265698 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Texas  
Vaccinated:2006-10-25
Onset:2006-10-29
   Days after vaccination:4
Submitted: 2006-10-31
   Days after onset:2
Entered: 2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO73AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR OE84AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO862D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Decreased appetite, Dehydration, Diarrhoea haemorrhagic, Intestinal obstruction, Intussusception, Irritability, Lethargy, Leukocytosis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. Labs and Diagnostics: Ab
CDC Split Type:

Write-up: Pt. is a 2 mo infant that recived his immunizations on 10/25/06 (pediarix, HiB, PCV and Rotateq). He had 2 days with reported fever, improved by day 3, on day 5 his parents noticed irritability, decreased appetite and also reported 2 emesis and one epysode of diarrhea with blood and mucus. They presented to our office where I found a sick looking infant, lethargic and mildly dehydrated. On physical exam he had abdominal pain. Abdominal films revealed several air-fluid levels and distention. Pt was admitted to hospital, I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. 11/01/2006: MR received from PCP revealing well baby exam of October 25, 2006 where infant received Pediarix, pneumococcal vaccine, and Rotateq./pc 11/3/2006: MR received from overnight hospital stay documenting fever for several days post vax which resolved, and infant was doing well. Five days post vax infant became irritable and lethargic, with poor appetite, and was noted to have had one episode of bloody stool the day prior, and continued to have mucus in his stool. Infant was admitted to the hospital at this time to R/O intussusception. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day. Infant was discharged. No d/C summary dictated./pc Report received from pediatrician revealing F/U exam for intussusception on 11/2/2006: no fever, no vomiting, increased appetite. Stool to be sent to CDC for analysis/pc


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