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This is VAERS ID 272200

(NOTE: This result is from the 4/13/2011 version of the VAERS database)

Case Details

VAERS ID: 272200 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Texas  
Vaccinated:2006-12-19
Onset:2007-02-09
   Days after vaccination:52
Submitted: 2007-02-13
   Days after onset:4
Entered: 2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Clostridium difficile toxin test, Colectomy, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Occult blood positive, Rotavirus test negative, Urinary system X-ray, Urine analysis normal, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC Split Type:

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


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