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This is VAERS ID 321669

Case Details

VAERS ID: 321669 (history)  
Form: Version 1.0  
Age: 0.21  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2008-08-01
Onset:2008-08-06
   Days after vaccination:5
Submitted: 2008-08-08
   Days after onset:2
Entered: 2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC Split Type:

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


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