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This is VAERS ID 278725

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

Case Details

VAERS ID: 278725 (history)  
Form: Version .0  
Age: 0.5  
Gender: Male  
Location: California  
Vaccinated:2007-03-15
Onset:2007-04-11
   Days after vaccination:27
Submitted: 2007-05-16
   Days after onset:35
Entered: 2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08657B / 3 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 3 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Enema administration, Intussusception, Irritability, Medication error
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: See the vaccine history attached. 8 month old baby diagnosed with intussuscetion on April 11, 2007 had third rotavirus vax on March 15. DTaP-HBV-POL (Diphtheria, Tetanus, acellular Pertussis, Hepatitis B, Polio) 3/15/2007, 1/2/2007, 10/31/2006 HBV adul"t (Hepatitis B) 9/1/2006 HIB PRP-OMP (Haemophilus influenzae b) 1/2/2007, 10/31/2006 PNUcn (Pneumococcal conjugate, pneumonia) 3/15/2007, 1/2/2007, 10/31/2006 ROT5 (Rotavirus live, pentavalent) 3/15/2007, 1/2/2007, 10/31/2006


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=278725


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