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This is VAERS ID 281912

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

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) / PFIZER/WYETH 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.


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