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This is VAERS ID 290658

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

Case Details

VAERS ID: 290658 (history)  
Form: Version .0  
Age: 0.5  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2007-08-27
Onset:2007-09-04
   Days after vaccination:8
Submitted: 2007-09-14
   Days after onset:10
Entered: 2007-09-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2657AA / 2 - / -
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1246F / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF164AA / 2 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal X-ray, Abdominal mass, Abdominal pain, Barium enema abnormal, Chest X-ray normal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Information has been received from a physician concerning a 6 month old female who on 27-AUG-2007 was vaccinated with her third dose of Rotateq. On 04-SEP-2007 the patient had been admitted to a local hospital for a suspected intussusception. On 05-SEP-20"07 was sent to a children''''s hospital. Medical attention was sought via hospital admission. There was no product quality complaint. No further information is available.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=290658


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