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This is VAERS ID 272130

Case Details

VAERS ID: 272130 (history)  
Form: Version 1.0  
Age: 0.33  
Gender: Female  
Location: Michigan  
Vaccinated:2007-02-07
Onset:2007-02-10
   Days after vaccination:3
Submitted: 2007-02-12
   Days after onset:2
Entered: 2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Enema administration, Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussusception & ascites. Barium enema not successful at reducing ileoileal intussusception.
CDC Split Type:

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


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