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This is VAERS ID 308364

Case Details

VAERS ID: 308364 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Female  
Location: Iowa  
Vaccinated:2007-11-08
Onset:2007-12-27
   Days after vaccination:49
Submitted: 2008-02-21
   Days after onset:56
Entered: 2008-03-27
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Enema administration, Intussusception, Peritonitis
SMQs:, Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC Split Type:

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


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