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This is VAERS ID 308859

Case Details

VAERS ID: 308859 (history)  
Form: Version 1.0  
Age: 0.33  
Sex: Female  
Location: Kentucky  
Vaccinated:2008-03-07
Onset:2008-03-14
   Days after vaccination:7
Submitted: 2008-04-03
   Days after onset:20
Entered: 2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

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:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC Split Type:

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


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