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This is VAERS ID 275807

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

Case Details

VAERS ID: 275807 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: California  
Vaccinated:2007-03-23
Onset:2007-03-28
   Days after vaccination:5
Submitted: 2007-04-09
   Days after onset:12
Entered: 2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1242F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031-2 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bacteria stool identified, Carbon dioxide decreased, Clostridial infection, Culture stool positive, Feeling cold, Gastrointestinal haemorrhage, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Heart rate increased, Ileostomy, Intensive care, Intestinal infarction, Intestinal ischaemia, Intestinal resection, Intussusception, Irritability, Jejunostomy, Lethargy, Livedo reticularis, Poor peripheral circulation, Pulse pressure decreased, Red blood cell count decreased, Rotavirus test negative, Shock, Small intestinal resection, Surgery, Swelling, Tachycardia, Urine output decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ischaemic colitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None PMH: delivered at term by c-section due to lack of progression. Had been developing normally w/o difficulty.
Allergies:
Diagnostic Lab Data: HR 180-200 on arrival. C. diff positive in stool. RBC 2.47, HBG/HCT 7.6/21.5. CO2 18. LABS: Hgb initially 12g & dropped to 7g w/n 5 hours. Transfused. Acidotic. Rotavirus neg. Multiple pages of lab results received.
CDC Split Type:

Write-up: Pt presented with GI bleed 3 days post vacinnation and became lethergic, mottled, with severe swelling. Pt was taken to the ED on 03/28. He was later found with acute intussusception and bowel was resected. Currently in PICU. 5/15/07 Received medical records from hospital which reveal patient experienced fussiness, bloody stools & massive GI bleed. Initially seen at outlying ER where patient found to be in shock & transferred to higher level of care. Admitted from 3/28-5/3/07. Pulses & perfusion were extremely poor, he was tachycardic, poor urine output & he was cold & mottled. Surgical consult done, central line placed & patient transfused. Taken to OR on 4/3/07 where found ischemia & infarction of small bowel. Resection of jejunum done; leaving only approx 30 cm jejunum. Proximal jejunostomy created w/ileostomy & mucous fistula performed using approx 15 cm of terminal ileum. Started on TPN & very slowly built up to 5 mL/TID at d/c oral feeding. Treated w/multiple antibiotics while hospitalized & developed c. difficile. Continued on TPN at d/c w/Home Health follow up due to high output jejunostomy. FINAL DX: ischemia & infarction of small bowel; resection of small bowel w/creation of jejunostomy.


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