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This is VAERS ID 264682

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

VAERS ID: 264682 (history)  
Form: Version .0  
Age: 0.4  
Gender: Male  
Location: Georgia  
Vaccinated:2006-09-28
Onset:2006-09-30
   Days after vaccination:2
Submitted: 2006-10-13
   Days after onset:13
Entered: 2006-10-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - - / -
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES - / - - / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0777F / 0 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal pain, Anaemia, Diarrhoea haemorrhagic, Intestinal perforation
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Barium enema X ray 10/02/06 revealed intussusception.
CDC Split Type:

Write-up: Information has been received from a physician concerning a 4 month old male, with no reported medical history, who on 9/28/06 was vaccinated with a first 2 ml oral dose of Rotavirus vaccine (lot 654970/0777F). Concomitant vaccines administered on the sam"e day included a dose of Prevnar, a dose of Hib and a dose of Pediarix. It was reported that, on approx 9/30/06, the pt initially presented with edpsodic excruciating abdominal pain and was diagnosed with colic at the ER of the hospital. The next day the


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