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This is VAERS ID 300449

Case Details

VAERS ID: 300449 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-07-31
Onset:2007-11-10
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2007-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21310AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AB / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690E / UNK LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578R / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal X-ray, Abdominal pain, Barium enema, Bronchial hyperreactivity, Cough, Enema administration, Full blood count abnormal, Intussusception, Nasopharyngitis, Platelet count increased, Ultrasound scan abnormal, Upper respiratory tract infection, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abd x-ray, U/S abnormal; CBC - increased WCC 19.5, Pl 520. LABS: KUB & abdominal x-ray c/w IS. WBC 19.5 (H), neutros 71.2% (H), lymphs 23.6% (L), plts 520 (H). Enema reduced.
CDC Split Type:

Write-up: Abdominal pain, R/O intussusception - URI, cold and cough 1 week. Intussusception continued U/S. + Abd X-ray. Successful reduction by Barium enema. On Albuterol too, ? RAD. Received flu vaccine 10/30/2007, SP lot # U2462AA, LAT. 12/20/07 Patient experienced runny nose, cough/cold symptoms x 1 week w/diarrhea x 3 days & vomiting x 1 day. When seen in clinic, parent revealed patient had been in hospital 11/10-11/11/2007 for IS. 12/28/07 Reviewed hospital medical records which reveal patient experienced cough x 2 wks,irritability, colicky abdominal pain & vomiting x 1 day. Family member had been ill w/gastritis 1 wk prior. Admitted 11/10-11/11/2007. Surgery consult done. Progressed well s/p reduction & d/c to home. FINAL DX: intussusception, enema reduced.


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