| VAERS ID: |
270992 (history) |
| Form: |
Version .0 |
| Age: |
0.2 |
| Gender: |
Male |
| Location: |
North Carolina |
| Vaccinated: | 2006-10-30 |
| Onset: | 2007-01-11 |
| Days after vaccination: | 73 |
| Submitted: |
2007-01-22 |
| Days after onset: | 11 |
| Entered: |
2007-01-24 |
| Days after submission: | 2 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B070AA / 0 |
RL / IM |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
0279F / 0 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES |
B08658A / 0 |
LL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0577F / 0 |
- / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal discomfort,
Haematochezia,
Intussusception,
Lethargy,
Pallor,
Platelet count increased,
Surgery,
Vomiting,
White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (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 symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC Split Type: NC07010
Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool. |
