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This is VAERS ID 303464

Case Details

VAERS ID: 303464 (history)  
Age: 0.5  
Gender: Unknown  
Location: Michigan  
Vaccinated:2007-10-29
Onset:2007-10-29
   Days after vaccination:0
Submitted: 2008-01-15
   Days after onset:78
Entered: 2008-01-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Viral rash, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0712USA01669

Write-up: Information has been received from a physician and an office manager concerning a 6 month old patient who on approximately 29-OCT-2007 was vaccinated PO with a fourth dose of Rotateq (no lot number was provided) in place of PREVNAR. Concomitant vaccinations administered on that same day included a dose of Varivax (MSD), MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD) and a dose of of FLUZONE. Subsequently the patient developed a viral rash which had since resolved. It was unknown whether medical attention was sought. It was noted that the patient had already received Rotateq at 2 months, 4 months and 6 months. There was no product quality complaint. Additional information has been requested. 02/11/2010 Follow-up information has been received from a physician concerning a 12 month old male with no pre-existing conditions or drug allergies who on 29-OCT-2007 at 14:00 was vaccinated PO with a fourth dose of GARDASIL (lot# 09024). There was no illness at the time of vaccination. Concomitant vaccinations administered that same day at 14:00 included the first SC does of VARIVAX (lot# 659159/1369U) in the left thigh, the first SC dose of MMR II (lot# 657344/0527U) in the left thigh, the fourth IM dose PREVENAR (lot# 370143D) in the right thigh. No labs or dianostic studies were performed. Subsequently the patient recovered. Additional information has been requested.


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