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This is VAERS ID 313034

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 313034 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Missouri  
Vaccinated:2008-03-31
Onset:2008-04-26
   Days after vaccination:26
Submitted: 2008-05-22
   Days after onset:26
Entered: 2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC CS4763 / 0 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal pain, Abnormal behaviour, Barium double contrast, Barium enema, Colectomy, Crying, Decreased appetite, Dehydration, Diarrhoea haemorrhagic, Explorative laparotomy, Ileostomy, Intussusception, Irritability, Oral intake reduced, Resuscitation, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC Split Type:

Write-up: Presented to ER (April 26 th 2008)for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


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