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This is VAERS ID 486747

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

Case Details

VAERS ID: 486747 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: New York  
Vaccinated:2013-02-05
Onset:2013-03-07
   Days after vaccination:30
Submitted: 2013-03-12
   Days after onset:4
Entered: 2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal mass, Appendicectomy, Barium enema, Barium enema abnormal, Blood calcium decreased, Blood chloride increased, Blood glucose increased, Blood magnesium increased, Blood phosphorus decreased, Blood potassium decreased, Central venous catheterisation, Diarrhoea, Enema administration, Explorative laparotomy, Gastrointestinal tube insertion, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intestinal operation, Intussusception, Laparoscopic surgery, Lethargy, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte percentage increased, Neutrophil percentage decreased, Pallor, Red blood cell count decreased, Ultrasound abdomen abnormal, Ultrasound scan normal, Vomiting, White blood cell count increased, X-ray abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (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), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 4/1/2013 hospital records received for DOS 3/7-11/2013. US abdomen, X-ray abdomen, air enema abnormal. Blood: WBC 17.2 K/mm3 (H), neutros 52.6% (L), monos 14.2% (H), RBC 3.62 M/mm3 (N), Hgb 8.8 g/dL (L), Hct 27.1% (L), MCV 74.9 fL (L), MCH 24.3 pg (L), K 2.9 mEq/L (L), glucose 121 mg/dL (H), Cl 115 mEq/L (H), Ca 8.1 mg/dL (L), PO4 3.3 mg/dL (L), Mg 2.4 mg/dL (H).
CDC Split Type:

Write-up: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction. The following information was obtained through follow-up and/or provided by the government. 4/1/2013 hospital records received for DOS 3/7-11/2013. D/c Dx: intussusception, s/p exploratory laparotomy w/ reduction of the intussusception, & s/p appendectomy. Pt transferred from outside facility w c/o 1 day hx bloody bright red stools per rectum. PE: pallor, lethargy, vomiting, diarrhea, bloody stools, abdominal mass. Seen previous day for same. Intussusception per US. Tx''t: air enema reduction attempted (unsuccessful), laparoscopic converted to open reduction, appendectomy, central line, PICU, NG tube, ABX. Feedings gradually started, tolerated w/o difficulty. D/c''d home in stable condition w/ care & f/u instructions.


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