This is VAERS ID 303464
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| VAERS ID: | 303464 (history) | Vaccinated: | 2007-10-29 | | Age: | 0.5 | Onset: | 2007-10-29, Days after vaccination: 0 | | Gender: | Unknown | Submitted: | 2008-01-15, Days after onset: 78 | | Location: | Michigan | Entered: | 2008-01-21, Days after submission: 6 | |
| 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 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | MMR: MEASLES + MUMPS + RUBELLA (MMR II) | MERCK & CO. INC. | | | UN | UN | | PNC: PNEUMO (PREVNAR) | PFIZER/WYETH | | | UN | UN | | ROTHB5: 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:
| | 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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=303464
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