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This is VAERS ID 274366

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

Case Details

VAERS ID: 274366 (history)  
Form: Version .0  
Age: 0.4  
Gender: Female  
Location: New York  
Vaccinated:2007-01-17
Onset:2007-03-07
   Days after vaccination:49
Submitted: 2007-03-19
   Days after onset:11
Entered: 2007-03-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 1 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal tenderness, Barium double contrast, Blood culture negative, Blood gases abnormal
SMQs:, Acute pancreatitis (broad), Lactic acidosis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Information has been received from a health professional concerning a 6 month old female, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq on 19-OCT-2006 and 17-JAN-2007 (Lot# 655866/1110F), re"spectively. Concomitant vaccinee administered on 17-JAN-2007 included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, a dose of IPOL, a dose of PedvaxHIB (manufacturer unknown) and a dose of Prevnar. It was re


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