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This is VAERS ID 315651

Case Details

VAERS ID: 315651 (history)  
Form: Version 1.0  
Age: 0.44  
Sex: Male  
Location: California  
Vaccinated:2008-06-05
Onset:2008-06-07
   Days after vaccination:2
Submitted: 2008-06-09
   Days after onset:2
Entered: 2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Ultrasound abdomen abnormal, Urinary system X-ray, Urine output decreased, Vomiting, X-ray abnormal
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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, 2 days
   Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC Split Type:

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


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