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This is VAERS ID 271978

(NOTE: This result is from the 5/14/2017 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
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Feeding disorder, Intussusception, Irritability
SMQs:, Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (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: WAES0702USA00218

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 into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.


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