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This is VAERS ID 339389

Case Details

VAERS ID: 339389 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2009-01-06
Onset:2009-02-08
   Days after vaccination:33
Submitted: 2009-02-10
   Days after onset:2
Entered: 2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Hypophagia, Intussusception, Laparoscopy, Lethargy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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, 9 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus infection, acute serositis & periappendicitis. Blood, urine, stool & CSF c/s neg. CSF tests WNL.
CDC Split Type:

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


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