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This is VAERS ID 278716

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

Case Details

VAERS ID: 278716 (history)  
Form: Version .0  
Age: 0.6  
Gender: Male  
Location: Oklahoma  
Vaccinated:2007-05-14
Onset:2007-05-15
   Days after vaccination:1
Submitted: 2007-05-16
   Days after onset:1
Entered: 2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690B / 3 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Band neutrophil count increased, Blood culture negative, Carbon dioxide decreased, Diarrhoea
SMQs:, 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema.
CDC Split Type:

Write-up: Fever, diarrhea, diagnosis of intussusception.


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