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This is VAERS ID 483887

(NOTE: This result is from the 9/17/2013 version of the VAERS database)

Case Details

VAERS ID: 483887 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: California  
Vaccinated:2013-02-08
Onset:2013-02-08
   Days after vaccination:0
Submitted: 2013-02-10
   Days after onset:2
Entered: 2013-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B377AA / 0 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UH691AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB314A / - - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal distension, Anion gap increased, Barium enema abnormal, Blood potassium increased, Enema administration, Gastrointestinal disorder, Gastrointestinal tube insertion, Haematochezia, Hypophagia, Intussusception, Irritability, Laparoscopic surgery, Laparotomy, Lymphocyte percentage increased, Monocyte percentage increased, Neutrophil percentage decreased, Small intestinal resection, Somnolence, Ultrasound abdomen abnormal, Urine ketone body present, Urine leukocyte esterase positive, Urine output decreased, Vomiting, Vomiting projectile, White blood cell count normal, X-ray abnormal
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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), Tumour lysis syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound confirming diagnosis The following information was obtained through follow-up and/or provided by the government. 5/2/2013 hospital records received for DOS 2/10-14/2013. Abdominal X-ray: multiple dilated loops small bowel compatible w/ small bowel obstruction. Abdominal US: intussusception causing small bowel obstruction. Blood: WBC 9.8 K/uL (N), neutros 46% (L), lymphs 42% (H), monos 11% (H), K 5.6 mEq/L (H), agap 21 (H). UA: leukocyte esterase (+), ketones (+). Barium enema: abnormal.
CDC Split Type:

Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception. The following information was obtained through follow-up and/or provided by the government. 2/15/2013 PCP records received for DOS 2/8/2013. No information abstracted. 5/2/2013 hospital records received for DOS 2/10-14/2013. D/c Dx''s: 1) intestinal intussusception; 2) intestine duplication. Pt presented w/ 1 day hx projectile emesis, poor PO intake, fussiness, decreased wet diapers, abdominal distension. On admission pt had BM w/ streak of blood. Tx''t: enema administration, laparoscopic & mini laparotomy reduction w/ resection of small bowel duplication cyst, NG tube, pain control. Pt d/c''d home in stable condition w/ care & f/u instructions.


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