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This is VAERS ID 311012

Case Details

VAERS ID: 311012 (history)  
Form: Version 1.0  
Age: 0.1  
Gender: Male  
Location: Missouri  
Vaccinated:2008-04-15
Onset:2008-04-20
   Days after vaccination:5
Submitted: 2008-04-23
   Days after onset:3
Entered: 2008-04-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Enema administration, Intussusception, Vomiting, X-ray with contrast upper gastrointestinal tract
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H) Atypical Lymph 12% (H) Anisocytosis slight Poikilocytosis slight. CHEM - CO2 19 mmol/L (L). Abdominal X-ray - bowel gas and soft tissue mass. Barium Air Contrast enema. Ultrasound Abdomen - consistant with intussusception. Urinalysis - Ketones 1+. Urine culture - Enterococcus species.
CDC Split Type:

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


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