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This is VAERS ID 272130

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 272130 (history)  
Form: Version .0  
Age: 0.3  
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 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08670F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Culture urine negative, Diverticular hernia, Enema administration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Rash erythematous, Rhinorrhoea, Surgery, Ultrasound abdomen abnormal, Urine analysis abnormal, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (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? 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 intussus
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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