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This is VAERS ID 535973

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 535973 (history)  
Form: Version 1.0  
Age: 0.36  
Gender: Male  
Location: Florida  
Vaccinated:2014-06-30
Onset:2014-07-05
   Days after vaccination:5
Submitted: 2014-07-08
   Days after onset:3
Entered: 2014-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ML5D7 / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35260 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB420A / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Decreased appetite, Faeces discoloured, Intensive care, Intestinal obstruction, Intussusception, Occult blood positive, Rectal haemorrhage, Somnolence, Ultrasound abdomen abnormal, Urinary system x-ray abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (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), Noninfectious diarrhoea (broad), Hypoglycaemia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: NO
Preexisting Conditions: UMBILICAL HERNIA - 553.1
Allergies:
Diagnostic Lab Data: KUB & Ultra Sound
CDC Split Type:

Write-up: This 4 month old has increased sleepiness and decreased appetite followed by onset of bright red blood per rectum. He than had 2 bowel movements, which were described as melanotic or very dark stool that was heme-positive. At an outside hospital, he had 2 episodes of emesis, which had bilious tinge. He was transfered to ICU at the hospital. KUB and ultrasound were obtained. KUB was suggestive of bowel obstruction. Ultrasound was notable for intussusception. The patient did undergo a hydrostatic reduction and was found to have an ilecolonic intussuseption to the level of the splenic flexure. Parents report no fever or diarrhea. Patient did receive the Rotarix vaccine on June 30, 2014. The patient is shedding virus in the stool. The child is otherwise well grown and healthy without any signficant clinical symptoms prior to the hours, according to the parents.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=535973


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