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This is VAERS ID 308360

Case Details

VAERS ID: 308360 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Connecticut  
Vaccinated:2008-02-14
Onset:2008-03-20
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 2 MO / PO

Administered by: Military       Purchased by: Military
Symptoms: Blood test, Haematemesis, Haematochezia, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
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: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC Split Type:

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.


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