VAERS ID: |
270981 (history) |
Form: |
Version .0 |
Age: |
0.2 |
Gender: |
Male |
Location: |
California |
Vaccinated: | 2006-12-10 |
Onset: | 2007-01-08 |
Days after vaccination: | 29 |
Submitted: |
2007-01-23 |
Days after onset: | 15 |
Entered: |
2007-01-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1008R / - |
- / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
094JF / - |
- / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Appendicectomy,
Barium enema,
Diarrhoea,
Haematochezia,
Intussusception SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (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? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception. CDC Split Type:
Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/0"7 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduct |