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This is VAERS ID 346278

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 346278 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: South Carolina  
Vaccinated:2009-04-03
Onset:2009-05-10
   Days after vaccination:37
Submitted: 2009-05-13
   Days after onset:3
Entered: 2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / - RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C87338 / - LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Bowel movement irregularity, Crying, Gastritis, Haematochezia, Intestinal resection, Intussusception, Irritability, Lethargy, Nasal congestion, Pyrexia, Rectal haemorrhage, Skin turgor decreased, Surgery, Tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC Split Type:

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=346278


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