Age: 0.34
Sex: F
Vaccine: DTAP, HBHEPB, IPV, PNC, RV5
Symptoms: Monocyte count normal, Neutrophil count increased, Platelet count increased, Retching, Sepsis
Clinical narrative: admitted to MC 5/10/2007 with intussusception after receiving Rotateq on 5/9/2007. A 4-month-old female who presented with the acute onset of vomiting earlier tonight while she was with the grandparents.  She had a 45 minutes spell of one vomiting episode after the other.  At the end of 45 minutes, she was having dry heaves and wretching.  She has been afebrile without any diarrhea or rashes, but she is now acting lethargic.  While she was with the grandparents, she had a brief cyanotic spell, the exact length that time she was cyanotic is unclear.  They got her in the car seat and were driving her to seek medical care.  She vomited and became cyanotic in her car seat.  So they took her to the nearest fire station.  The firemen/paramedics assessed her and thought that she was stable and okay for transport via private car to the Emergency Room.  She presented to the ER at 1953 on 05/10/2007.  She is now doing better after getting a bolus of normal saline per the emergency room physician.  Of note, she had her 4-month vaccines just yesterday on 05/09/2007, but interestingly, there were no problems yesterday shortly after having the vaccines and she did fine with her two-month set of vaccines.  She has been breastfed up until just recently, when the mom has started supplementing with formula.  She believes that yesterday she supplemented on 4 separate occasions with Formula. ASSESSMENT: A 4-month-old with acute, very forceful vomiting.  There is some associated lethargy and 2 separate cyanotic spells.  This could be an early case of viral gastroenteritis seeing as that she just was at our clinic on 05/09/2007, would like to rule out sepsis.  There is a leukocytosis with a 2+ left shift.  Other possibilities also exist. PLAN: 1.  Vitals every 2 hours x4, if they are stable then every 4 hours. 2.  Cardiorespiratory plus continuous sat monitor, daily weights, strict Is and Os. 3.  Diet will cautiously breast feed her, but if there is any further vomiting, we will have to transition the Pedialyte and give only 5 to 10 mL per feeding approximately every 5 to 15 minutes. 4.  She is already received 50 mL of normal saline.  We will now start D5 quarter normal saline to run at 30 mL an hour.  After next void, we will add 20 mEq of potassium chloride per L. 5.  Ceftriaxone 50 mg/kg per dose IV given in the emergency room. 6.  Repeat CBC on 05/11/2007 in the a.m.  05/31/2007 MR received for 2 hospital stays 5/10-11/07 and 5/17-18/07 for c/o vomiting and lethargy.  Cyanotic spells noted as well on first admission.. First admission was 24hrs following well child check where Rotateq was administered.  Child developed intense bilious vomiting accompanied by pallid spells. Bloody stools noted the following AM.  Suspected IS, however diagnostics did not identify IS.  Improved with IV fluids and D/Cd. 2nd episide 1 week later with bilious vomiting, fussiness, and pallid spells. Again improved with IV fluids and was D/C. Principle DX 5/11/07 Intussusception. DC Dx 5/18/07: Gastrointestinal Bleed.  Pallid spells.  Possible small bowel obstruction.  Addendum: 6/11/2007 Per CDC: "Please have the email below scanned into VAERS for  # 278441 and please have the intussusception code removed." "I reviewed the medical records provided for Vaers #278441 of a 4 mo previously healthy child with 2 hospital admission for severe, bilious vomiting.  She had received RotaTeq vaccine 24 hours prior to her first episode of vomiting.  Infant also noted to have heme-positive stool.  While clinical symptoms could be consistent with intussusception, neither upper GI nor air enema nor Gastrografin enema showed evidence of intussusception.  Small bowel series did not show any obstructing lesion in the small bowel.  No intussusception was visualized by either air or Gastrogafin enema.  Not diagnostic of intussusception." M.D.  Immunization Safety Office  Office of the Chief Science Officer  Centers for Disease Control and Prevention