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This is VAERS ID 281912

Case Details

VAERS ID: 281912 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Texas  
Vaccinated:2007-05-07
Onset:2007-05-30
   Days after vaccination:23
Submitted: 2007-06-12
   Days after onset:13
Entered: 2007-06-15
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692D / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0235U / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Intussusception, Obstruction, Pyrexia, Small intestinal resection, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Noted to have birth defects of grossly deformed right ear & spot on kidney
Allergies:
Diagnostic Lab Data: Abdominal xray-$gobstruction LABS: WBC 13, Na 133, K 5.6, BUN 10. KUB c/w SBO.
CDC Split Type:

Write-up: This patient developed fever/vomiting and then had small bowel resection for intussusception at medical center. 6/19/07 Received vax record from PCP which confirms RO lot & dose as reported. 7/26/07 Received medical records from hospital via fax from CDC. Records are primarily for ENT but IS mentioned on clinic note having been perfomed 6/1/07 w/resection of 5cm of bowel resected. 7/27/07 Received hospital medical records which reveal patient experienced nausea, bilious vomiting, fever & lethargy x 4 days. Admitted 5/30-6/3/07. Tx w/IV antibiotics & taken to OR. Small bowel IS found at proximal mid ileum. Did well post op w/o complications. FINAL DX: Intussusception; s/p exp lap & small bowel resection w/reanastomosis. Records faxed to CDC.


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