Age: 0.3
Sex: F
Vaccine: DTP, HBHEPB, IPV, PNC
Symptoms: Constipation, Diarrhoea
Clinical narrative: Information has been received from a physician concerning a 12 week old Asian/Caucasian female with no know past medical history or allergies who on 12/5/01 and on 2/27/02 was vaccinated with a first (lot #639442/0483L) and a second dose (lot #640206/0935L) of haemophilus B conjuage vaccine (+) hepatitis B vaccine recombinant (yeast), respectively, IM in the right thigh. Concomitant vaccinations on 12/5/01 included the first dose of diphtheria toxoid/pertussis vaccine/ tetanus IM in the left thigh (lot # U0341BA), the first dose of poliovirus vaccine (IPOL) SC in the left thigh (lot # T1446) and the first dose of Streptococcus pneumoniae vaccine (PREVNAR) IM in the right thigh (lot # 484133). Concomitant therapy on 2/27/02 included the second dose of poliovirus vaccine (IPOL) (lot # U0425), SC in the left thigh, and the second dose of diphtheria toxoid/pertussis vaccine/tetanus IM in the left thigh (lot # U0540DA). There was no illness at the time of vaccination or other concomitant medication. Subsequently, the patient developed obstipation which had not resolved in 5 weeks. Follow up information from a health care professional noted that the patient developed infrequent bowel movements as reported by his father on 12/21/01. The patient was referred to a gastroenterologist. On 1/25/02, the patient was seen by a gastroenterologist in consultation for her history of constipation. The patient had a history of a full-term, normal spontaneous vaginal delivery with a birth weight of 6 pounds and 9 ounces. There were no reported complications during the pregnancy or delivery, and the patient was discharged home on day two of life. The patient was exclusively breast fed but was recently introduced to stage one baby foods. There had been no difficulty with weight gain. There was no difficulty with passage of meconium, and she stooled regularly until two months of age. At the time of her first immunizations the onset of constipation was noted. The patient would go up to five days without passing a bowel movement. The stools overall were noted to be soft in nature. It was noted that the patient did get uncomfortable after four to five days without stooling. The longest the patient has gone was up to seven days  without a bowel movement. The family needed to perform rectal stimulation on a number of occasions. They have tried Karo syrup and olive oil without any improvement. The patient has no history of surgery or hospitalization. There were no concomitant medications. The patient's mother, father and sister are reported as being in good health. The physical examination was reported as: well appearing and in no acute distress; weight 14 pounds 3 ounces and height was 25.5 inches; normocephalic, extraocular motions intact, pupils equal and reactive to light; pharynx benign, neck was supple, no thyromegaly; lungs clear; no diffuse adenopathy; cardiac-regular rate and rhythm without murmur; pulses 2+ throughout; no heave or thrill, bowel sounds present; abdomen soft, nontender, nondistended, without organomegaly; anus was perhaps slightly anteriorly displaced; normal rectal tone; no significant amount of stool in the rectum despite not having stooled for 5 days; stool was guaiac positive; extremities without clubbing, cyanosis or edema; neurological exam was nonfocal and revealed normal sensation to light tough; no rashes were noted and skin was normal on palpitation. The assessment was patient with a history of constipation, with an exam without any abdominal distention, without any significant stool in the vault, and with some slightly guaiac positive stool. The family was instructed to try introducing some cereal into the patient's diet as well as some prune juice or apple juice. Follow up reported that on 1/8/02 and on 1/16/02 the patient had infrequent bowel movements, and loose stools on 3/26/02, per patient's father. It was also noted that on 4/27/02 the patient was vaccinated with a third dose of diphtheria toxoid/pertussis vaccine/tetanus IM in the left thigh (lot # U0540BA) and a second dose of Streptococcus pneumoniae vaccine (PREVNAR) IM in the right thigh (lot # 484876). The outcome was unknown. Additional information is not expected.