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This is VAERS ID 283993

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 283993 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-06-06
Onset:2007-06-30
   Days after vaccination:24
Submitted: 2007-07-02
   Days after onset:2
Entered: 2007-07-06
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674A / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Abdominal X-ray, Barium enema, Computerised tomogram, Full blood count, Intussusception, Laboratory test, Surgery, Ultrasound scan, Urine analysis
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
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:
Preexisting Conditions: PMH: none noted. NKDA.
Allergies:
Diagnostic Lab Data: Abdominal X-ray, U/S, CT, barium enema, CBC, UA, Chem labs. Labs and Diagnostics: CBC normal, electrolytes normal, CXR and KUB normal. Abd ultrasound with abnormal segment of bowel in the RUQ with thickening (bowel in bowel?) Suggests upper GI or Barium enema. Labs and Diagnostics: CT scan of abdomen (+) for intussusception. Abdominal X-ray with dilated bowel loops. Barium enema performed with IS identified but reduction was not possible x 3 attempts.
CDC Split Type:

Write-up: Intussusception 6/30 Surgical correction 7/1. Infant presented to ER with multiple episodes of vomiting, no diarrhea. Child transfered to admitting hospital. 07/30/2007 MR received from admitting hospital for DOS 7/1-4/2007. She was transferred via helicopter for eval and tx for an irreducible Intussusception. Child had an exploratory lap with reduction of ileocolic intussusception. Intussuscepted bowel was 2'' to a Meckel diverticulum. Resection of Meckel Diverticulum and ileum also done. Discharge DX: Intussusception. Meckel Diverticulum.


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