VAERS ID: |
308360 (history) |
Form: |
Version .0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: | 2008-02-14 |
Onset: | 2008-03-20 |
Days after vaccination: | 35 |
Submitted: |
0000-00-00 |
Entered: |
2008-03-27 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC14B073AA / 1 |
RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. |
1244F / 0 |
RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
A0273 / 1 |
LL / IM |
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC |
C45153 / 1 |
LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
0903U / 1 |
- / PO |
Administered by: Military Purchased by: Military Symptoms: Blood test,
Haematemesis,
Haematochezia,
Intussusception SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: None Current Illness: No Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis. Allergies: Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphra CDC Split Type:
Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c. |