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This is VAERS ID 271978

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 271978 (history)  
Form: Version .0  
Age: 0.3  
Gender: Male  
Location: New Jersey  
Vaccinated:2007-01-16
Onset:2007-01-29
   Days after vaccination:13
Submitted: 2007-02-08
   Days after onset:10
Entered: 2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal pain, Enema administration, Feeding disorder, Haematochezia, Intussusception
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#/"08475 or possibility 08475"/") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came i


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