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This is VAERS ID 291827

Case Details

VAERS ID: 291827 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Michigan  
Vaccinated:2007-07-23
Onset:2007-09-20
   Days after vaccination:59
Submitted: 2007-09-27
   Days after onset:7
Entered: 2007-10-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 2 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Diarrhoea, Haematochezia, Intussusception, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC Split Type:

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


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