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This is VAERS ID 275896

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

Case Details

VAERS ID: 275896 (history)  
Form: Version .0  
Age: 0.5  
Gender: Female  
Location: Unknown  
Vaccinated:2007-01-09
Onset:2007-02-12
   Days after vaccination:34
Submitted: 2007-04-09
   Days after onset:55
Entered: 2007-04-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZB075AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UE901AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8670K / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 0 - / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Bacteria stool identified, Barium enema, Blood urine present, C-reactive protein increased, Diarrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Pseudomembranous colitis (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, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown. PMH: newborn jaundice.
Allergies:
Diagnostic Lab Data: Surgery 02/14/07 - bowel intussusception. Labs and Diagnostics: WBCs 19.4 with neutrophils 79%, bands 2, lymphs 18 and monos 1. C-reaticive protein (+). UA with 500 leukocytes and 50 ketones, (+) blood and WBCs. Stool cx (+) for C. diff
CDC Split Type:

Write-up: Information has been received from a nurse practitioner and a physician concerning a 24-week-old female with no allergies and with a history of fevers (on and off) who on 01-NOV-2006 and 09-JAN-2007 was vaccinated PO with the first and second doses of Rot"ateq (Lot #''''s 654352/0410F and /1082F, respectively). There was no concomitant medication. On 15-DEC-2006 the patient experienced fever. This fever was not related to therapy with Rotateq. On 26-DEC-2006 the patient experienced left eye ptosis. On 12-JAN


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