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This is VAERS ID 274629

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 274629 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: D.C.  
Vaccinated:2007-03-20
Onset:2007-03-22
   Days after vaccination:2
Submitted: 2007-03-23
   Days after onset:1
Entered: 2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08655E / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Barium enema, Colostomy, Explorative laparotomy, Gastrooesophageal reflux disease, Haematochezia, Intestinal perforation, Intussusception, Mechanical ventilation, Ultrasound abdomen abnormal, White blood cell count increased, X-ray abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal perforation (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific dysfunction (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION,
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC Split Type:

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.


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