| VAERS ID: |
301951 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Gender: |
Male |
| Location: |
Ohio |
| Vaccinated: | 2007-12-13 |
| Onset: | 2007-12-17 |
| Days after vaccination: | 4 |
| Submitted: |
2008-01-02 |
| Days after onset: | 16 |
| Entered: |
2008-01-08 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C2797AA / 2 |
UN / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF292AB / 2 |
UN / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
A0298 / 2 |
UN / UN |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B70143D / 2 |
UN / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0904U / 2 |
MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Cyst,
Explorative laparotomy,
Ileectomy,
Intussusception,
Rectal haemorrhage,
Ultrasound abdomen abnormal,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdominal x-ray small bowel obstruction. US intussusception right upper quadrant.
CDC Split Type:
Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy. |
