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This is VAERS ID 292396

Case Details

VAERS ID: 292396 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Kentucky  
Vaccinated:2007-08-24
Onset:2007-09-23
   Days after vaccination:30
Submitted: 2007-09-27
   Days after onset:4
Entered: 2007-10-08
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 02657AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0016U / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21009 / 1 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981B / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0972U / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Abnormal hemoglobin; FAV Variant Barts. PMH: failed NB hearing screen.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Intussusception. CBC with 3.7 WBCs. Blood culture (+) Gram (+) cocci in clusters-Staphylococcus species. Surgical pathology of bowel segment shows ulcerated areas with perforation
CDC Split Type:

Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.


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