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This is VAERS ID 314989

Case Details

VAERS ID: 314989 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Florida  
Vaccinated:2008-03-07
Onset:2008-03-26
   Days after vaccination:19
Submitted: 2008-06-05
   Days after onset:71
Entered: 2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Enema administration, Haematochezia, Intussusception, Pallor, Ultrasound scan abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10, blood culture gram positive cocci. Stool guaiac positive. 6/24/08-records received-Ultrasound of abdomen negative. X-ray abdomen normal. Enema with contrast:intussusception, unsuccessful reduction attempt.
CDC Split Type:

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


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