| VAERS ID: |
458488 (history) |
| Form: |
Version 1.0 |
| Age: |
0.35 |
| Sex: |
Male |
| Location: |
Arizona |
| Vaccinated: | 2012-06-14 |
| Onset: | 2012-06-17 |
| Days after vaccination: | 3 |
| Submitted: |
2012-06-29 |
| Days after onset: | 12 |
| Entered: |
2012-06-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR |
C4155AA / 2 |
LL / IM |
| PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH |
F63667 / 2 |
RL / IM |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
A41FB285A / 2 |
MO / PO |
Administered by: Public Purchased by: Public
Symptoms: Abdominal pain,
Barium enema,
Clostridium difficile colitis,
Enema administration,
Haematochezia,
Intussusception,
Irritability,
Stool analysis,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Hypoglycaemia (broad)
Life Threatening? Yes
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: cephalexin 125mg/5ml 6ml qd
Current Illness: None
Preexisting Conditions: Grade 5 vesicoureteral reflux diagnosed at 6 weeks of age
Allergies:
Diagnostic Lab Data: Contrast barium enema, stool studies
CDC Split Type:
Write-up: On above date and approximate time, infant began with fussiness, abdominal pain and bilious vomiting and was taken to the ED. Was later admitted to the hospital and had grossly blood stools. Diagnosed with intussusception of colon and C. difficile colitis. |
