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This is VAERS ID 426959

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 426959 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Indiana  
Vaccinated:2010-11-29
Onset:2010-12-03
   Days after vaccination:4
Submitted: 2011-07-07
   Days after onset:215
Entered: 2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 1 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 1 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 - / PO

Administered by: Private       Purchased by: Public
Symptoms: Appendicectomy, Computerised tomogram abdomen abnormal, Explorative laparotomy, Haematochezia, Intestinal dilatation, Intestinal operation, Intussusception, Irritability, Painful defaecation, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (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 dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC Split Type:

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130513&IDNUMBER=426959


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