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This is VAERS ID 272460

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 272460 (history)  
Form: Version .0  
Age: 0.7  
Gender: Male  
Location: Missouri  
Vaccinated:2007-01-03
Onset:2007-02-03
   Days after vaccination:31
Submitted: 2007-02-17
   Days after onset:14
Entered: 2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE992AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Antimicrobial susceptibility test resistant, Barium enema, Blood culture negative, Computerised tomogram abnormal, Culture stool negative, Culture urine negative, Culture wound positive, Dehydration, Extubation, Gastrointestinal tube insertion, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Sputum culture positive, Ultrasound abdomen abnormal, Vomiting, X-ray with contrast upper gastrointestinal tract
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal perforation (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: URI
Preexisting Conditions: Gastroesophageal reflux PMH: GERD, recurrent otitis media w/PE tube placement 12/06. Family hx of asthma.
Allergies:
Diagnostic Lab Data: Abdominal ultrasound on 2/7/2007 demonstrated intussception LABS: +MRSA nasal swab. All blood, urine & stool c/s neg. Wound c/s 2/14 grew abundant pseudamonas & e.coli. Trach c/s 2/20 grew pseudamonas & tenotrophomonas. CT of abd 2/23
CDC Split Type:

Write-up: Patient developed GI symptoms (vomiting) on 2/3/2007 (31 days after receiving 3rd Rotateq). Was diagnosed with intussception on 2/7/2007. Suffered perforation of intestine during attempt to reduce by Barium enema, requiring emergent laparotomy and reanastomosis of small bowel. Suffered a 2nd bowel perforation on 2/12/2007. Illness resulted in ICU admission, intubation, probable sepsis. 3/15/07 Received partial medical records from hospital which reveal patient admitted 2/7/07 after experienced +IS s/p perforation x 2 w/OR repair who developed fever, elevated WBC, increasing discomfort & irritability. Returned to OR on 2/15 for transverse colon perforation. FINAL DX: none at present as patient still hospitalized. Peritonitis, either resistant bacteria such as MRSA or fungal were considered likely. T/C to hospital to determine D/C status of patient & to request D/C Summary if available. Patient d/c to home 3/14. No D/C Summary dictated yet. Will request later. 4/10/07 Received D/C summary from hospital which reveals patient admitted from 2/7/07-3/14/07. Admitted w/abdominal pain & emesis x approx 5 days w/lethargy & dehydration. Treated at outlying hospital w/IVF prior to transfer for surgery on 2/7/07 was exp lap w/ileocecectomy w/primary anastomosis; then, lysis of adhesions & repair of transverse colon perforation on 2/12/07. Condition was critical & worsened prior to second surgry w/patient remaining intubated & in PICU. After second surgery & continued IVF, antibiotics & TPN, had gradual improvement & was successfully extubated. Despite treatment, continued to have intermittent fevers & multiple w/ups were done, all were neg for source of infection. Transitioned from TPN to NJ feeds & was transferred to regular peds floor. Gradually, oral feeds were introduced & tolerated & NJ feeds were d/c. Patient had become accustomed to MSO4 pain med & had extensive wean w/ativan & methadone. Bowel function had returned to normal by d/c to home w/f/u w/PCP & surgery. FINAL DX: Intussusception compl


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