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This is VAERS ID 307761

Case Details

VAERS ID: 307761 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Female  
Location: North Carolina  
Vaccinated:2008-01-30
Onset:2008-03-04
   Days after vaccination:34
Submitted: 2008-03-21
   Days after onset:16
Entered: 2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Crying, Dehydration, Diarrhoea, Enema administration, Fatigue, Intussusception, Pyrexia, Surgery, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC Split Type:

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


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