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This is VAERS ID 303729

Case Details

VAERS ID: 303729 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Male  
Location: California  
Vaccinated:2008-01-11
Onset:2008-01-12
   Days after vaccination:1
Submitted: 2008-01-21
   Days after onset:9
Entered: 2008-01-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C42993 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose 111. Stool 1+ WBCs. Stool cx (-).
CDC Split Type:

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


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