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This is VAERS ID 279315

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 279315 (history)  
Form: Version .0  
Age: 0.6  
Gender: Female  
Location: Connecticut  
Vaccinated:2007-03-28
Onset:2007-05-10
   Days after vaccination:43
Submitted: 2007-05-18
   Days after onset:8
Entered: 2007-05-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08670H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Blood electrolytes normal, Constipation, Dehydration, Haematocrit normal, Inappropriate schedule of drug administration, Intussusception, Occult blood positive, Surgery, Ultrasound abdomen abnormal, Upper respiratory tract infection, Vomiting, White blood cell count
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC Split Type:

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100302&IDNUMBER=279315


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