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This is VAERS ID 307038

Case Details

VAERS ID: 307038 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:2008-03-04
Onset:2008-03-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Barium enema abnormal, Enema administration, Faeces discoloured, Intussusception, Urinary system X-ray, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception successfully reduced. 3/12/08-Abdominal sono no evidence of ileocolic intussusception.
CDC Split Type:

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


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