| VAERS ID: |
281912 (history) |
| Form: |
Version .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 / 0 |
LL / UN |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF018AA / 0 |
RL / UN |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC |
B08692D / 0 |
LL / UN |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0235U / 0 |
- / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal X-ray,
Blood potassium increased,
Blood sodium decreased,
Blood urea normal,
Explorative laparotomy,
Intussusception,
Lethargy,
Nausea,
Obstruction,
Pyrexia,
Small intestinal anastomosis,
Small intestinal resection,
Surgery,
Urinary system X-ray,
Vomiting,
White blood cell count
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (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, 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. |
