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This is VAERS ID 341949

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

VAERS ID: 341949 (history)  
Form: Version .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 / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF402HH / 0 UN / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PFIZER/WYETH B0009 / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D33126 / - UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1472X / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal distension, Abdominal tenderness, Acute respiratory distress syndrome, Blood electrolytes abnormal, Blood gases, Blood lactic acid, Colectomy, Colitis ischaemic, Computerised tomogram abnormal, Death, Disseminated intravascular coagulation, Echocardiogram abnormal, Electrocardiogram abnormal, Endotracheal intubation, Haematochezia, Ileocolostomy, Intensive care, Intestinal resection, Intussusception, Laparotomy, Leukocytosis, Mechanical ventilation, Multi-organ failure, Rectal haemorrhage, Respiratory distress, Septic shock, Ultrasound Doppler abnormal, Ultrasound abdomen abnormal, Urinary system X-ray, X-ray abnormal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)

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 ac
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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