| VAERS ID: |
273694 (history) |
| Form: |
Version .0 |
| Age: |
0.5 |
| Gender: |
Female |
| Location: |
California |
| Vaccinated: | 2006-12-27 |
| Onset: | 2007-02-03 |
| Days after vaccination: | 38 |
| Submitted: |
2007-03-08 |
| Days after onset: | 33 |
| Entered: |
2007-03-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B069AA / 2 |
LA / IM |
| HIBV: HIB (ACTHIB) / AVENTIS PASTEUR |
UF021AB / 2 |
LA / IM |
| PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES |
BO8678K / 2 |
RA / IM |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0779F / 1 |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal mass,
Abdominal tenderness,
Barium enema,
Colectomy,
Explorative laparotomy,
Haematochezia,
Intussusception,
Laparotomy,
Mucous stools,
Ultrasound abdomen abnormal,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium Enema/laparotomy Lab/diagnostics received 3/15/07-BE:intussusception to rectosigmoid only reducible to hepatic flexure. US abdomen confirmed intussusception.
CDC Split Type:
Write-up: Intussusception with exploratory laparotomy with right hemicolectomy and partial ileectomy. 03/15/07-records received from facility for DOS 2/3-2/10/07 DC DX: Intussusception status post right hemicolectomy. Previously healthy infant developed emesis and bloody mucoid stools PE:WNL except for abdomen large palpable mass in mid left which was mobile, somewhat tender to palpation and firm. Right hemicolectomy 2/4/07- |
