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This is VAERS ID 354417

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 354417 (history)  
Form: Version 1.0  
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 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Full blood count, Haematochezia, Intussusception, Metabolic function test, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

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 (H) MCV um3 (L). CHEM - Potassium 6.8 mEq/L (H) Chloride 113 mEq/L (H) Glucose 111 mg/dL (H).
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.


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