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This is VAERS ID 267654

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

Case Details

VAERS ID: 267654 (history)  
Form: Version .0  
Age: 0.3  
Gender: Female  
Location: Colorado  
Vaccinated:2006-09-14
Onset:2006-10-25
   Days after vaccination:41
Submitted: 2006-11-22
   Days after onset:28
Entered: 2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B071AA / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES UE962AD / 1 RL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08651E / 1 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Colitis, Gastroenteritis, Gastrooesophageal reflux disease, Haematochezia, Intussusception
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific dysfunction (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES
CDC Split Type:

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O"AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND S


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=267654


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