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This is VAERS ID 267654

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 267654 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Colorado  
Vaccinated:2006-09-14
Onset:2006-10-25
   Days after vaccination:41
Submitted: 2006-11-22
   Days after onset:28
Entered: 2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES UE962AD / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08651E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Colitis, Gastroenteritis, Gastrooesophageal reflux disease, Haematochezia, Intussusception, Irritability, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES LABS: WBC 26.3 on admit.
CDC Split Type:

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND SPITTING AFTER FEEDING. TRIED ZANTAC IN PAST WITHOUT RELIEF SO STOPPED. LAST VOID IN AM. 10/26/06, 10:15AM: FOC STATES CHILD VOMITING 4X DAY FOR PAST 2 DAYS MOSTLY AFTER BREASTFEEDING FORMULA. BROUGHT CHILD INTO ED. 2 DAYS AGO HAD X1 LARGE STOOL. INTERMITTENT FUSSINESS. AM X 1 BLOODY STOOL. NO FEVER OR URI SXS. DX: INTUSSUSCEPTION, INCOMPLETE REDUCTION BY AIR ENEMA. PLAN: ADMIT OR FOR INTUSSUSCEPTION REDUCTION PROCEDURE: RQL LIMITED LAPAROTOMY W/ILEOCOLIC INSTUSSUSCEPTION REDUCTION. APPENDECTOMY. NO COMPLICATIONS. DISCHARGED. 11/16/06: 6M WELL CHILD VISIT. HAD INTUSSUCEPTION, BUT DOING WELL. EATING SOLIDS, NO CHRONIC DIARRHEA OR CONSTIPATION. IMMS ADMIN, BUT ROTAVIRUS HELD. 12/12/06 Received medical records from hospital which reveal patient presented to ER s/p 36 hours of vomiting, fussiness & then 1 bloody diaper on 10/26/06. Air enema revealed incomplete reduction of ileocolic IS which was initially present at the sigmoid level & reduced to the hepatic flexure. Taken to OR & findings revealed distal ileum & appendix intussuscepted within right colon extending to mid transverse level which was reduced w/o difficulty & appendix removed. D/C to home on 10/28/06. Final DX: Intussusception, surgically reduced.


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