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This is VAERS ID 279026

(NOTE: This result is from the 6/11/2011 version of the VAERS database)

Case Details

VAERS ID: 279026 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: Alabama  
Vaccinated:2007-05-08
Onset:2007-05-13
   Days after vaccination:5
Submitted: 2007-05-19
   Days after onset:6
Entered: 2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal pain, Barium double contrast, Barium enema, Central venous catheterisation, Colectomy, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Endotracheal intubation, Enema administration, Explorative laparotomy, Intensive care, Intussusception, Laboratory test normal, Lethargy, Lymphocyte count decreased, Mucous stools, Occult blood, Pallor, Platelet count increased, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), 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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC Split Type:

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


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