| VAERS ID: |
271927 (history) |
| Form: |
Version .0 |
| Age: |
0.5 |
| Gender: |
Male |
| Location: |
Connecticut |
| Vaccinated: | 2007-01-29 |
| Onset: | 2007-02-07 |
| Days after vaccination: | 9 |
| Submitted: |
2007-02-07 |
| Days after onset: | 0 |
| Entered: |
2007-02-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B097AB / 2 |
UN / IM |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
UT2191KA / 0 |
UN / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08691A / 2 |
UN / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0942F / 2 |
- / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Barium double contrast,
Body temperature increased,
Cough,
Dehydration,
Diarrhoea,
Haematochezia,
Intussusception,
Nasal congestion,
Ultrasound abdomen abnormal,
Ultrasound scan,
Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), 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? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings
CDC Split Type:
Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema. |
