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This is VAERS ID 271927

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 271927 (history)  
Form: Version .0  
Age: 0.54  
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: Diarrhoea, Intussusception, Ultrasound scan, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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 c/w reactive inflammatory disease or viral pneumonia. KUB shoed dilated bowel. Abd US showed RUQ IS, likely ileocolic. Transfer hospital LABS: CBC 13.4, segs 30%, lymphs 61%, monos 7%, baso 1%. Abdominal US revealed IS in RUQ w/dilated small bowel loops proximally & small amount free fluid. Air contrast enema reduced w/o complication.
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.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=271927


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