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This is VAERS ID 268712

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

Case Details

VAERS ID: 268712 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Washington  
Vaccinated:2006-08-17
Onset:2006-09-28
   Days after vaccination:42
Submitted: 2006-12-08
   Days after onset:71
Entered: 2006-12-12
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / - - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / - - / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. - / - - / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0146F / 2 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Intussusception, Irritability, Pyrexia, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/2/06 X Ray normal, diagnostic lab normal, body temp fever.
CDC Split Type:

Write-up: Information has been received from a physician concerning a 23 week old male, with no significant medical history, who, on 16-Jun-2006 was vaccinated with an oral, 2.0 ml, first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine) (Lot"#653661/0146F). Concomitant vaccination administered on 16-Jun-2006 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of Hib conj vaccine (tetanus toxoid) (ACTHIB), and a dose if hepatitis B vir


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