| VAERS ID: |
354417 (history) |
| Form: |
Version .0 |
| Age: |
0.3 |
| Gender: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2009-07-30 |
| Onset: | 2009-08-11 |
| Days after vaccination: | 12 |
| Submitted: |
2009-08-17 |
| Days after onset: | 6 |
| Entered: |
2009-08-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
C3237AA / 1 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
D48928 / 1 |
RL / IM |
| ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FA802A / 1 |
- / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal distension,
Barium enema,
Blood chloride increased,
Blood glucose increased,
Blood potassium increased,
Dehydration,
Diarrhoea,
Full blood count,
Gastroenteritis,
Haematochezia,
Intussusception,
Lethargy,
Mean cell volume decreased,
Metabolic function test,
Mucous stools,
Occult blood positive,
Pallor,
Rotavirus test negative,
Ultrasound abdomen abnormal,
Vomiting,
White blood cell count increased,
X-ray abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), 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 symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (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, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (
CDC Split Type:
Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception. |
