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This is VAERS ID 464436

Case Details

VAERS ID: 464436 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Male  
Location: New York  
Vaccinated:2012-08-07
Onset:2012-09-08
   Days after vaccination:32
Submitted: 2012-09-10
   Days after onset:2
Entered: 2012-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329A / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH526AB / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918245 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB208A / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Activated partial thromboplastin time, Diarrhoea, Diarrhoea haemorrhagic, Enema administration, Flatulence, Full blood count, Hypophagia, Intussusception, Irritability, Laboratory test, Prothrombin time, Pyrexia, Ultrasound abdomen abnormal, Urinary system X-ray, Urine output decreased, Viral upper respiratory tract infection, Vomiting
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), 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), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mother states that this morning patient started acting fussier than usual and had decreased PO intake and few wet diapers (mom reports a total of three prior to presentation to the ED). At around 2 pm he vomited which mom described as milky appearing (non-bloody, non-bilious). At around 4 pm he had one episode of diarrhea (non-bloody) followed by another 3 episodes of vomiting. Mom decided to bring him into the ED at that time. Of note, patient had a recent episode of viral URI for which he presented to the ED on 8/28. Supportive measures were provided and mom was instructed to f/u with PMD and use anti-pyretics for fever reduction. In the ED, the patient had an episode of grossly bloody diarrhea. The patient was bolused x 2, and labs sent including PT/PTT, T+S, CBC and venous panel. A KUB was done which showed a paucity of bowel gas. An abdominal US was performed which was consistent with intussusception. Surgery was consulted. The patient underwent successful reduction of his intussusception via air enema prior to being transferred to the floor.


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