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This is VAERS ID 326271

(NOTE: This result is from the 5/13/2013 version of the VAERS database)

Case Details

VAERS ID: 326271 (history)  
Form: Version .0  
Age: 0.4  
Sex: Female  
Location: Connecticut  
Vaccinated:2008-09-15
Onset:2008-09-22
   Days after vaccination:7
Submitted: 2008-09-25
   Days after onset:3
Entered: 2008-09-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Endotracheal intubation, Enema administration, Explorative laparotomy, Extubation, Gastrointestinal tube insertion, Haematochezia, Ileus, Intensive care, Intestinal anastomosis, Intestinal anastomosis complication, Intussusception, Irritability, Parenteral nutrition, Surgery, Ultrasound abdomen abnormal, Vitello-intestinal duct remnant, Vomiting, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Congenital, familial and genetic disorders (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)

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, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC Split Type:

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


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