VAERS ID: |
275949 (history) |
Form: |
Version .0 |
Age: |
0.3 |
Gender: |
Female |
Location: |
Indiana |
Vaccinated: | 2007-02-16 |
Onset: | 2007-04-09 |
Days after vaccination: | 52 |
Submitted: |
2007-04-10 |
Days after onset: | 1 |
Entered: |
2007-04-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B070AA / 1 |
RL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF051AA / 1 |
LL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
B08646F / 1 |
LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1016F / 1 |
- / PO |
Administered by: Private Purchased by: Private Symptoms: Barium double contrast,
Colostomy,
Diarrhoea haemorrhagic,
Gastrointestinal necrosis,
Intussusception,
Laparotomy,
Mucous stools SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Ischaemic colitis (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: records received 6/21/07-Air contrast enema demonstrated ileocolic intussusception to the level of the sigmoid and reducible only to mid-transverse colon. CDC Split Type:
Write-up: Patient presented with bloody diarrhea 4/8/7. DX of intussusception - Surgically reduces. Had Rotateq 2/16/07. No known association. 06/06/07-received observation note for DOS 4/9/07-DC Probably intussusception. Two day history of low grade fever and vomiting, decreased appetite. On day of admission developed bloody diarrhea. Transferred to another facility 6/21/07-records received from receiving facility for DOS 4/10-4/13/07-DC DX: Intussusception and necrotic cecum. Presented with 24 hour history of emesis and bloody mucous per rectum. Exploratory laparotomy and reduction of ileocolic intussusception with ileal cecetomy and primary ileal colostomy. |