| VAERS ID: |
326440 (history) |
| Form: |
Version .0 |
| Age: |
0.3 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2008-06-03 |
| Onset: | 2008-07-08 |
| Days after vaccination: | 35 |
| Submitted: |
2008-09-29 |
| Days after onset: | 83 |
| Entered: |
2008-09-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B141AA / 1 |
RL / IM |
| HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UF349AA / 1 |
LL / IM |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
C45887 / 1 |
LL / IM |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. |
1830U / 1 |
- / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal distension,
Constipation,
Diarrhoea,
Enema administration,
Explorative laparotomy,
Gastrointestinal necrosis,
Haematochezia,
Intensive care,
Intestinal anastomosis,
Intussusception,
Lethargy,
Necrotising colitis,
Parenteral nutrition,
Pyrexia,
Small intestinal resection,
Surgery,
Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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 ulceration (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow)
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, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC Split Type:
Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis. |
