This is VAERS ID 300448

Case Details

VAERS ID:	300448 (history)
Form:	Version 1.0
Age:	0.35
Gender:	Female
Location:	Maine

Vaccinated:	2007-10-18
Onset:	2007-11-15
Days after vaccination:	28
Submitted:	2007-12-13
Days after onset:	28
Entered:	2007-12-19
Days after submission:	6

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR	C2489AA / 2	LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.	0072U / 2	RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR	202402 / 2	LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B08657F / 2	RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1053U / 2	MO / PO

Administered by: Private Purchased by: Unknown
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: radiological LABS: KUB dialted loops of small bowel. Abdominal US (+) for IS x 2. Air enema reduction of IS x 2.
CDC Split Type:

Write-up: Intussusception requiring reduction. Repeat intussusception needing second procedure. 12/21/07 Reviewed vax record which confirms dose & lot #s as reported. 12/28/07 Reviewed hospital medical records which reveal patient experienced vomiting, bloody stool, reduced oral intake, irritability & lethargy. Admitted 11/16-11/17/2007. Enema successfully reduced IS. Admitted for overnight observation. Did well & was d/c to home. Readmitted 11/19-11/20/2007 for recurrence of vomiting & bloody stools. 2nd abdominal US (+) for IS & was successfully reduced w/air contrast enema. Kept overnight for observation. Did well & d/c to home. FINAL DX: Recurrent ileocolic intussusception at hepatic flexure, enema reduced x 2.

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