Age: 0.2
Sex: M
Vaccine: DTAP, HBHEPB, IPV, PNC, RV5
Symptoms: White blood cell count normal
Clinical narrative: Information has been received from a physician via medical records concerning a 20 week old premature (WAES #0707USA01443) male with a history of diarrhoea, candidal dermatitis (all reported in WAES #0908USA00770) and circumcision and a family history of diabetes and obesity who on 07-NOV-2007 and 08-JAN-2008 was vaccinated with the first and second dose of COMVAX. Secondary suspect therapy included three doses of ROTATEQ administered on 07-NOV-2007, 08-JAN-2008 and 10-MAR-2008, respectively. Concomitant therapy included three doses of PREVENAR, DAPTACEL and POLIO. On 07-JAN-2008, the patient was taken to the physician with concerns of extra fussy in "last couple days" and very gassy. It was reported that the baby had some constipation and plenty wet diapers. Physical examination showed no abnormality. No treatment was given. On 16-JAN-2008 the patient was seen in the office for upper respiratory infection symptoms including cough, congestion, difficulty breathing and nasal drainage for the 2-3 days. He had no significant fever, sore throat, headache, swollen glands, ear pain , ear drainage or vision problems of the eyes, nausea, vomiting, diarrhea, abdominal pain, constipation, change in stool habits. He had no change in appetite. He had no dysuria, urinary frequency, hematuria or skin rashes. He had been slightly irritable, otherwise no insomnia or neurologic complaints. It was reported that the baby lived with his mother and the mother spent the majority of her days at maternal grandparents hours where maternal grandparents smoke indoors. Physical examination showed the baby was fussy with mild respiratory distress. Respiratory rate was 58. His temperature was 98.7 axillary. Nasal Mucosa congested with some stringy mucoid rhinorrhea noted. Lung examination revealed coarse rhonchi throughout, positive subcostal retractions, positive suprasternal retractions, somewhat tachypneic. The child was noted to have grunting respirations and auto-Positive End Expiration Pressure (PEEP). The rest of the physical exam was otherwise normal. He had tachycardia, otherwise his rhythm was regular without appreciable murmur. He was diagnosed with bronchiolitis and respiratory distress. A chest x-ray obtained at the office was unremarkable. O2 saturation was 98% on room air but due to his grunting and retractions he was admitted to the hospital for further evaluation and treatment. Complete blood cell as well as Respiratory Syncytial Virus swab would be tested (results not provided). Bronchiolitis protocol was initiated. Supplemental O2 would be provided to keep his saturations greater than or equal to 92%. On 10-MAR-2008 the baby had an office visit. The patient had runny nose. On 06-JUN-2008 the patient presented to the emergency room with complaint of constipation and rectal pain. Patient had large bowel movement at approximately 19:30 and had bright red blood following the bowel movement. Patient's mother reported that he had problems with  constipation and cried with every bowel movement. Onset of the symptoms was reported as gradual and associated with hard stools and rectal bleeding. The patient's condition was exacerbated and relieved by nothing. Physical examination showed no abnormality. Lab tests included white blood cell 15.3 x 10e3/UL, red blood cell 4.92 x 10e6/UL, hemoglobin 11.8 g/d, hematocrit 35.5, mean corpuscular volume (MCV) 72.1 fl, mean corpuscular hemoglobin (MCH) 24.0, mean corpuscular hemoglobin concentration (MCHC) 33.3 g/dl, red cell distribution width (RDW) 15.4 %, mean platelet volume (MPV) 7.3 fl, blood platelet 273 10e3/UL. Abdomen radiology interpretation kidney, ureter and bladder were negative, no free air, no foreign body, no intestinal dilation, no radio-opaque stones seen, however, constipation present. The patient was diagnosed with constipation. The patient was discharged home with simple/moderate discharge teaching and follow up care which was done on 17-JUN-2008. On 07-JUL-2008 the patient was seen in the office for pulling at R ear and runny nose. The assessment included upper respiratory infection (URI) and was treated symptomatically. The patient subsequently developed adverse events after vaccination with MMR, first dose of VARICELLA and a fourth dose of HEP B (WAES # 0908USA00772). Information received on 03-AUG-2009 contained the following adverse experience: borderline cardiomegaly reported on chest X-ray (16-JAN-2008; congenital anomaly. Additional information has been requested. All medical records will be provided upon request.