| VAERS ID: |
275291 (history) |
| Form: |
Version 1.0 |
| Age: |
0.23 |
| Gender: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2007-01-15 |
| Onset: | 2007-03-12 |
| Days after vaccination: | 56 |
| Submitted: |
2007-03-30 |
| Days after onset: | 18 |
| Entered: |
2007-03-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B066AA / 1 |
LL / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UE972AA / UNK |
LA / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08657F / UNK |
RA / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0410F / 1 |
MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation,
Crying,
Enema administration,
Faeces hard,
Haematochezia,
Intussusception,
Surgery,
X-ray
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (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 (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC Split Type:
Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced. |
