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This is VAERS ID 339753

Case Details

VAERS ID: 339753 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: Tennessee  
Vaccinated:2009-01-06
Onset:2009-01-09
   Days after vaccination:3
Submitted: 2009-01-14
   Days after onset:5
Entered: 2009-02-18
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Enema administration, Fluid intake reduced, Hypersomnia, Hypophagia, Intussusception, Listless, Surgery
SMQs:, Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC Split Type:

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


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