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This is VAERS ID 311224

Case Details

VAERS ID: 311224 (history)  
Form: Version 1.0  
Age: 0.56  
Sex: Male  
Location: Hawaii  
Vaccinated:2007-11-28
Onset:2008-03-11
   Days after vaccination:104
Submitted: 2008-04-29
   Days after onset:49
Entered: 2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Enema administration, Haematochezia, Intussusception, Surgery, Ultrasound abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Dehydration (narrow)

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC Split Type:

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


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