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This is VAERS ID 302692

Case Details

VAERS ID: 302692 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Ohio  
Vaccinated:2007-11-01
Onset:2007-11-08
   Days after vaccination:7
Submitted: 2008-01-15
   Days after onset:68
Entered: 2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300B / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 1 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC Split Type:

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.


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