National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 272460

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 272460
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE992AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: URI
Preexisting Conditions: Gastroesophageal reflux
Allergies:
Diagnostic Lab Data: Abdominal ultrasound on 2/7/2007 demonstrated intussception
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 rean"astomosis of small bowel. Suffered a 2nd bowel perforation on 2/12/2007. Illness resulted in ICU admission, intubation, probable sepsis.


Changed on 12/8/2009

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE992AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 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, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 rean"astomosis 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


Changed on 1/5/2010

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 3/2/2010

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08670F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Sepsis, Small intestinal anastomosis, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 4/7/2010

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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 (PREVNAR7) 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: Barium enema, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Sepsis, Small intestinal anastomosis, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 8/31/2010

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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 PFIZER/WYETH B08670F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Culture wound positive, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Peritonitis, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 1/4/2011

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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) / PFIZER/WYETH B08670F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Culture wound positive, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Peritonitis, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


Changed on 4/13/2011

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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) / PFIZER/WYETH 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, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


Changed on 5/13/2011

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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) / PFIZER/WYETH 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, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


Changed on 6/11/2011

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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) / PFIZER/WYETH 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, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


Changed on 5/13/2013

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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) / PFIZER/WYETH B08670F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO
RV5: 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, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


Changed on 6/14/2014

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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) / PFIZER/WYETH B08670F / 2 RL / IM
RV5: 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, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


Changed on 2/14/2017

VAERS ID: 272460 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
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) / PFIZER/WYETH B08670F / 2 RL / IM
RV5: 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, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Lethargy, Paracentesis abdomen, Peritonitis, Pyrexia, Sepsis, Small intestinal anastomosis, Vomiting, X-ray with contrast upper gastrointestinal tract, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


Changed on 9/14/2017

VAERS ID: 272460 Before After
VAERS Form:(blank) 1
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE992AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Sepsis, Small intestinal anastomosis, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


Changed on 2/14/2018

VAERS ID: 272460 Before After
VAERS Form:1
Age:0.7
Gender:Male
Location:Missouri
Vaccinated:2007-01-03
Onset:2007-02-03
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE992AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intensive care, Intestinal perforation, Intubation, Intussusception, Laparotomy, Sepsis, Small intestinal anastomosis, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 revealed increased loculated fluid collection along superior liver capsule along w/decreased abd ascites. LABS: Admit WBC 4.4, Na 138, K2.6, cl 116. Abd US revealed IS. CT scan on 2/19 & 2/23 revealed loculated fluid collection along liver capsule. US on 2/23 for paracentesis. UGI on 3/1 showed bowel dilitation w/o obstruction.
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 complicated by small bowel perforation & transverse colon perforation. Per information received from the annual follow up patient did have the complication of intestinal perforation twice after diagnosis of intussusception, was hospitalized for greater than 1 month.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=272460&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166