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This is VAERS ID 341949

Case Details

VAERS ID: 341949 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Illinois  
Vaccinated:2009-03-06
Onset:2009-03-11
   Days after vaccination:5
Submitted: 2009-03-17
   Days after onset:6
Entered: 2009-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 3000AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF402HH / 1 UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PFIZER/WYETH B0009 / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D33126 / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1472X / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Intestinal resection, Intussusception
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-07-05
   Days after onset: 116
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 117 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: REGLAN
Current Illness: none
Preexisting Conditions: Down''s Syndrome; AV canal; Reflux (G-E); Myeloproliferative disorder 5/19/09-records received-PMH: Down Syndrome with transient myeloproliferative disorder. Congenital heart disease.
Allergies:
Diagnostic Lab Data: 5/21/09-records received-Echo abnormal. Ultrasound diagnosis of intussusception.. LABS and DIAGNOSTICS; Thyroid function tests abnormal. Creatinine levels high. Blood cultures (+). Echocardiogram. ECG - abnormal. CT - Abnormal. Lactic acids. Blood gases. Vascular Doppler - Abnormal. KBU - abnormal. Electrolytes abnormal.
CDC Split Type:

Write-up: Intussusception (ileo-cecal) requiring bowel resection. 5/19/09-records received for DOS 1/2/09 and 3/5/09 -clinic notes for follow-up-3/13/09-seen in clinic after presenting to ED with large bloody stools times 2 days, developed respiratory distress. Transfusions. Intubated. PICU. Impression: rectal bleeding, DIC, leukocytosis. 5/21/09-operative report received for DOS 3/13/09-exploratory laparotomy with right hemicolectomy and ileocolostomy. DX: Intussusception. Presented with C/O abdominal tenderness and distended abdomen, rectal bleeding. Post operatively developed ARDS, ventialtor dependent. Subsequent surgery 5/7/09 Median sternotomy, PDA ligation, pulmonary artery banding, insertion of right femoral arterial line. 5/12/09-subsequent surgery for closure of sternal wound. Failure to wean from ventilator. 8/11/09 Hospital DC summary, ICD-9 codes received DOS 3/11/09 to 7/5/09. Assessment: Intussusception status post bowel resection, ischemic colitis - septic shock, multi organ system dysfunction. Additional clinical data abstracted: 5/28/09 Continued fever. Signs of sepsis. Parental decision to withdraw care on 7/5/09. Patient expired on 7/5/09. ICD-9 Codes: 786.05 Shortness of breath, 560.0 Intussusception, 286.6 Defibrination syndrome, 557.0 Acute vascular insufficiency of intestine, 785.52 Septic shock, 569.83 Perforation of intestine, 038.49 Septicemia due to gram-negative organism, 038.43 Septicemia due to Pseudomonas, 518.5 Pulmonary insufficiency following trauma and surgery, 745.69 Endocardial cushion defect, 747.0 Patent ductus arteriousus, 238.79 Neoplasm of uncertain behavior of other lymphatic and hematopoietic tissue, 995.92 Severe sepsis, 599.0 Urinary tract infection site not specified, 758.0 Down''s syndrome, 427.5 Cardiac arrest.


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