| VAERS ID: |
278716 (history) |
| Form: |
Version .0 |
| Age: |
0.6 |
| Gender: |
Male |
| Location: |
Oklahoma |
| Vaccinated: | 2007-05-14 |
| Onset: | 2007-05-15 |
| Days after vaccination: | 1 |
| Submitted: |
2007-05-16 |
| Days after onset: | 1 |
| Entered: |
2007-05-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B090BA / 3 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08690B / 3 |
RL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1232F / 3 |
- / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal X-ray,
Band neutrophil count increased,
Blood culture negative,
Carbon dioxide decreased,
Diarrhoea,
Enema administration,
Full blood count normal,
Haematochezia,
Intussusception,
Lymphocyte count decreased,
Neutrophil percentage increased,
Pyrexia,
Ultrasound kidney normal,
Urinary tract infection,
Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), 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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC Split Type:
Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI. |
